The Maryland Department of Health (MDH) has developed clinical criteria for appropriate use of hepatitis C medications (see link below). MedStar Family Choice (MFC) will follow these criteria in considering requests for treatment. The MDH and MFC expect strict adherence. For the most part, the MDH Criteria follow the guidelines set forth by the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America. However, there are several key points to consider:
- A liver biopsy or other accepted test (e.g., FibroSure) demonstrating fibrosis (Metavir score ≥ 2) is required before initiating therapy UNLESS the member has “a viral condition which is known (documented to) result in an accelerated hepatic disease (fibrosis) progression and /or hepatic decompensation than what is normally expected from the course of chronic HCV.” For example, members with HIV or hepatitis B do not have fibrosis requirements; their fibrosis level can be Metavir F0, F1, F1-2, etc. and qualify for treatment.
- A baseline viral load must be obtained within 90 days of the anticipated start of treatment.
- Mandatory virologic testing at 4, 12 and 24 weeks must be performed with the intent to discontinue treatment if there is inadequate viral response (defined in the MDH document).
- Initial medication approvals will be for 8 weeks of treatment. Additional medication will be approved only after lab testing is submitted at week 4 (and week 12 for patients in whom regimens extend greater than 12 weeks).
If you wish to prescribe hepatitis C medications, please complete the Hepatitis C Prior Authorization Form (see link below) and fax it to 410-933-2205. This form will also serve as a prescription that will be forwarded to CVS Caremark Specialty Pharmacy allowing your patient to receive his/her medication. For any questions, please contact Danielle Gerry, MD at 410-933-2295 or Patryce Toye, MD at 410-933-2204.