Texas

State of Hepatitis C
Medicaid Access:

C-

Texas

Liver damage restrictions

Texas requires moderate liver damage (F2 or greater) to qualify for treatment.

Sobriety restrictions

Texas requires screening for substance use within 90 days prior to submitting a prior authorization request.

Prescriber restrictions

Texas requires a prescription be written by or in consultation with a specialist.

Recommendations

  • Remove liver damage, sobriety and prescriber restrictions.
  • Maintain coverage parity across the FFS and MCO programs.
  • Consider waiving prior authorization for treatment-naïve individuals.

Note – due to the pending settlement and the fact that the new policy applies to FFS and MCOs, in the interest of time I am not including all 17 MCOs policies herein, as hopefully they’ll be irrelevant very soon.

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