Utah

Liver damage restrictions

Fee-For-Service (FFS) and two MCOs (Healthy U and Molina) do not have fibrosis criteria. One Managed Care Organization (MCO), SelectHealth Community Care, requires at least moderate liver damage (F2 or greater). One MCO (Health Choice Utah) requires severe liver damage (F3 or greater).

Sobriety restrictions

FFS does not have any sobriety restrictions. One MCO (SelectHealth Community Care) requires six months’ abstinence from alcohol or drug use before submitting a prior authorization request form. Three MCOs (Health Choice Utah, Healthy U, and Molina Healthcare of Utah) require screening and some form of counseling for drug or alcohol use.

Prescriber restrictions

FFS only requires a prescription be written by or in consultation with a specialist for patients that are not treatment-naïve and/or in specific circumstances which are outlined on the prior authorization form. One MCO (Molina Healthcare of Utah) does not require a specialist to prescribe treatment. The other three MCOs (Healthy U, SelectHealth Community Care, and Health Choice Utah) require prescriptions to be written by specialists.

Recommendations

• Require MCOs to impose FFS hepatitis C coverage criteria to achieve parity and improve access across the entire program.
• Ensure transparency regarding hepatitis C coverage requirements.