Prior Authorization Update: Hepatitis C

Date: 04/25/19

In order to better care for the health and wellbeing of Ambetter from Superior HealthPlan members, we regularly review Ambetter clinical policies to ensure members have the benefit of current industry standards.

GUIDELINE CHANGE: The clinical prior authorization guidelines for Hepatitis C treatment were updated July 2018. Coverage for direct acting combination antiretroviral medications has been expanded to allow for the treatment of all fibrosis score levels. For more information, please review the initial approval checklist of the clinical policy requirements for treatment of Chronic Hepatitis C Infection: Hepatitis C Prior Authorization Initial Approval Checklist

PREFERRED PRODUCTS: Ambetter’s preferred combination antiretroviral is Mavyret. The formulary is reviewed monthly and agents are subject to change.

SPECIALTY PHARMACY: Acaria Health is Ambetter’s preferred specialty pharmacy for members. To speak with a representative about submitting a prescription for your qualifying patients, please call 1-800-511-5144.

Please take a few minutes to review your patients’ charts and the Hepatitis C Prior Authorization Initial Approval Checklistto determine if they now meet the guidelines. To request a prior authorization review, please call our pharmacy benefit manager (PBM), Envolve Pharmacy Solutions at 1-866-399-0928 or fax your request to 1-866-399-0929.

For any questions, please contact your dedicated Account Manager.

For other formulary questions, please call the Superior Pharmacy Department at 1-800-218-7453 ext. 22080