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California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more

Updated Hepatitis C Treatment Criteria

Date: 09/28/18

Expanded inclusion criteria give patients greater access to treatment


California Health & Wellness Plan (CHWP) is updating the criteria for identifying hepatitis C virus (HCV) treatment candidates and the prior authorization criteria for certain HCV treatments. These updates are based on the California Department of Health Care Services (DHCS) All Plan Letter 18-013 and DHCS’ updated HCV treatment policy dated July 1, 2018.

While prior authorization is still required, the treatment inclusion criteria are expanded and give patients greater access to HCV treatment. Members not previously eligible may now potentially qualify for HCV treatment.

HEPATITIS TREATMENT GOALS

The goal of HCV treatment is to achieve a sustained virologic response (SVR), defined as undetectable HCV ribonucleic acid (RNA) in the blood for 12 or more weeks after completing antiviral treatment. For most patients, achieving an SVR is synonymous with curing hepatitis C. Achieving an SVR significantly decreases the risk of disease progression and the development of cirrhosis, liver cancer, liver failure, other extra-hepatic complications, and/or death.

POLICY CHANGES

Effective July 1, 2018, CHWP is required to follow the guidelines set forth in the new policy, Treatment Policy for the Management of Chronic Hepatitis C.

DHCS developed this new policy based on a review of the medical literature and the most recent guidelines and reports published by the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA).

Changes from the previous policy include, but are not limited to:

·         The guidelines for identification of treatment candidates removed the requirement of fibrosis stage F2 and greater or other qualifying clinical states. Now all patients with chronic HCV infection regardless of fibrosis stage/clinical state may be candidates for treatment, except those with a short life expectancy of less than 12 months.

·         The age requirement was modified from age 18 and older to the U.S. Food and Drug Administration (FDA)-approved age for use of the medication.

 

View the complete policy at www.dhcs.ca.gov/Pages/HepatitisC.aspx.