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.

  • Fibrosis requirements
    • Members with ANY fibrosis level are eligible for treatment. In other words, all fibrosis requirements are removed. As long as other criteria are met, members can receive treatment. Please note that a measurement of fibrosis (Fibrosure, Fibroscan, biopsy) is still required.  
  • 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.

Click here for the MDH Clinical Criteria for HCV Therapy.

Click here for the Hepatitis C Prior Authorization Form.

Click here for the Hepatitis C Checklist for Prescribers (which lists all necessary elements that must be submitted with the Prior Authorization form).

Information current as of: