Virginia

Liver damage restrictions

Fee-For Service (FFS) and Managed Care Organizations (MCOs) do not have liver damage restrictions.

Sobriety restrictions

FFS and MCOs do not have sobriety restrictions.

Prescriber restrictions

FFS and MCOs do not have prescriber restrictions for the preferred drugs, Mavyret and sofosbuvir/velpatasvir. FFS and MCOs do require that a specialist (gastroenterologist, hepatologist, transplant specialist, or infectious disease specialist) prescribe a non-preferred medication.

Recommendations

• Allow primary care providers to prescribe non-preferred regimens.
• Require continued parity between FFS and MCOs and maintain transparency regarding hepatitis C coverage criteria.
• Consider waiving prior authorization for treatment-naïve patients.