A new Medical Assistance Bulletin from the The Pennsylvania Department of Human Services, effective Dec. 17, issues updated handbook pages that include the requirements for prior authorization and the type of information needed to evaluate the medical necessity of prescriptions for Hepatitis C Agents submitted for prior authorization.
This bulletin applies to all licensed pharmacies and prescribers enrolled in the Medical Assistance (MA) Program and providing services in the fee-for-service delivery system, including pharmacy services to residents of long-term care facilities.
Most pertinently, this version formally incorporates the HBV screening criteria set by AASLD/IDSA HCV treatment guidelines. Providers should take note that if someone is negative for hepatitis BsAb, the provider will need to document a HBV immunization plan or counseling to receive the HBV immunization series.
Required documentation includes:
a. A complete hepatitis B immunization series
OR
b. Hepatitis B screening (sAb, sAg, and cAb)
AND
c. If positive for hepatitis B sAg, quantitative HBV DNA results
AND
d. If there is detectable HBV DNA, a treatment plan for hepatitis B consistent with AASLD recommendations
AND
e. If negative for hepatitis B sAb, a hepatitis B immunization plan or counseling to receive the hepatitis B immunization series
Read, download, and share the bulletin and updated handbook pages here.
