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Virginia*
Liver damage restrictions
Fee-For Service (FFS) and Managed Care Organizations (MCOs) do not impose liver damage restrictions.
Sobriety restrictions
FFS and MCOs do not impose sobriety restrictions.
Prescriber restrictions
FFS and MCOs do not impose prescriber restrictions for preferred drugs. For non-preferred drugs, FFS and MCOs require a specialist to prescribe (gastroenterologist, hepatologist, transplant specialist, or infectious disease specialist).
Recommendations
- Ensure parity between FFS and MCO coverage requirements
- Regain transparency for MCO coverage requirements
*Virginia Medicaid does not require prior authorization for preferred agents.
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