The Maryland Department of Health (MDH) developed and maintains 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 Criteria follow the guidelines set forth by the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America. Important information is below:

  • Members with ANY fibrosis level are eligible for treatment. Please note that a measurement of fibrosis (Fibrosure, Fibroscan, biopsy) is still required.
  • PLEASE SUBMIT THE FOLLOWING:
    • For patients WITHOUT cirrhosis

      • Hepatitis C viral load < 6 months old
      • Genotype
      • Fibrosis measurement < 1 year old (please note that NASH & ASH FibroSures are not accepted)
      • Office note < 6 months old
    • For patients WITH cirrhosis

      • INR, bilirubin, albumin < 90 days old
      • Hepatitis c viral load < 90 days old
      • Genotype o Fibrosis measurement < 1 year old (please note that NASH & ASH FibroSures are not accepted)
      • Office note < 90 days old

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. For any questions, please contact Lisa Speight, MD at 410-933-2263 or Patryce Toye, MD at 410-933-2204.

Click here for the MDH Clinical Criteria for HCV Therapy.

Click here for the Hepatitis C Prior Authorization Form.

Information current as of: