HCV Resources

This page includes general HCV info & resources, including state-specific information and resources for financial assistance for treatment.

According to the CDC: “Hepatitis C occurs as an acute infection that is most often asymptomatic and frequently develops into a chronic infection. New cases of acute hepatitis C have increased rapidly in the US since 2010, and have most often been associated with injection drug use. There is no vaccine against hepatitis C, but short-term treatment for chronic hepatitis C can clear the virus and cure the infection,” – CDC.gov

Visit our HCV community resource page for prevention, treatment, types of HCV, anti-stigma, and more:

 

Can’t afford treatment?

Explore resources to access patient assistance programs (PAPs)

View our brief guide on how to afford hepatitis C treatment:

 

State-Specific Info

  • Hepatitis C Medicaid Access Rating: D+

    • There is no requirement of minimum level of liver damage to qualify for hepatitis C treatment
    • All fibrosis levels qualify
    • No prescriber restrictions are imposed
    • Requires at least six months’ sobriety from substances and/or alcohol, proved by a screening, to receive treatment
    • Only allows one treatment in a patient’s lifetime
    • Resource

  • Hepatitis C Medicaid Access Rating: A+

    • Changed guidelines on January 4, 2022, and significantly improved Medicaid access to hepatitis C treatment
    • No prior authorization for Mavyret, the preferred treatment regimen, requirement
    • No requirement of minimum level of liver damage to qualify for treatment
    • No screening or sobriety requirement
    • No prescriber requirements
      • “Patients 19 years or younger, are post-liver transplant, have hepatocellular carcinoma awaiting liver transplant, have decompensated cirrhosis (Child Pugh B or C), have mixed genotype hepatitis, and previously treated with NS3/4A PI and NS5A inhibitor” must consult a specialist and attest that they will complete the treatment regimen
        • Will be screened for Hepatitis B and HIV
        • HCV RNA may be collected and submitted to renew authorization to complete treatment after Week 4
        • Prescriber must document HCV RNA at week 4 and post-completion of therapy
    • Resource

  • Hepatitis C Medicaid Access Ranking: B

    • Fee-for-Service (FFS) and five Managed Care Organizations (MCO) require a diagnosis of chronic hepatitis C to access treatment
      • One organization, University Family Care, does not have public coverage criteria listed
    • FFS and five MCOs require patients to be “in remission for past three months from the request date of treatment”
    • Those who have met criteria for a substance use disorder in the past 12 months must be enrolled in a treatment program.
      • University Family Care does not have public coverage criteria listed
    • There is a lack of transparency defining criteria for hepatitis C coverage within FFS and MCOs
    • Resource

  • Hepatitis C Medicaid Access Ranking: F

  • Requires severe liver damage, dependent on genotype to access treatment
  • Treatment dependent on whether patient has had previous treatment before
  • Requires abstinence from substances and alcohol for at least six months
  • If a patient currently uses substances, they must be enrolled in a rehabilitation program while accessing treatment.
  • Substance use history will be reviewed prior to approving access to treatment
  • Requires a specialist (i.e. hepatologist, gastroenterologist, etc.) or a provider that works directly under a specialist to prescribe treatment
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  • Hepatitis C Medicaid Access Ranking: A+

  • No liver damage requirements
  • No sobriety requirements
  • No prescriber requirements
  • Do not need prior authorization to access preferred treatment regimens
  • Resource

  • Hepatitis C Medicaid Access Ranking: A-

  • No liver damage restrictions
  • Rocky Mountain Health Plan, a Managed Care Organization, does not publish coverage criteria
    • Discrepancies between different Managed Care Organizations
  • No sobriety restrictions
  • Colorado Primary Care Case Management: requires provider with sufficient education or a specialist to prescribe treatment
  • Denver Health Medicaid choice requires a gastroenterologist, infectious disease specialist, hepatologist, or HIV specialist to prescribe treatment
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  • Hepatitis C Medicaid Access Ranking: B+

  • No liver damage restrictions
  • No sobriety restrictions
  • No prescriber restrictions
  • Authorization form requires patient to be 18 years or older, diagnosed with chronic hepatitis C, and whether patient has known malignancies or terminal disease
  • Prescriptions only allow treatments to be dispensed 14 days at a time once treatment was authorized
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  • Hepatitis C Medicaid Access Ranking: A-

  • No liver damage requirements
  • Require screening and counseling for patients who meet the criteria for substance use disorders
  • No prescriber restrictions
  • Informed Consent form for treatment asks patient to abstain from alcohol and illicit substance use during treatment; Not abiding by the informed consent form can result in termination of treatment
    • If patient is using substances or alcohol, they must enroll in counseling
    • Patients with HIV must measure and report CD4 count
  • Any patient can receive authorization
    • Patients can qualify for immediate treatment if they meet this criteria: show extrahepatic symptoms, have diagnosis of a comorbidity such as HIV, hepatitis B, Lymphoma, are awaiting organ transplant, or have fast progressing fibrosis
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  • Hepatitis C Medicaid Access Ranking: B+

  • No liver damage restrictions
  • Need to be screened and counseled for alcohol and substance use
  • Medstar Family Choice
    • Requires documentation of the patient’s ability to adhere to treatment and submissions of office visit notes about their substance use
  • Requires a prescription for treatment by a specialist
    • CareFirst Community Health Plan: if provider is not a specialist, then a one-time written consultation report from a specialist is required in the previous three months before treatment begins
    • Resource

  • Hepatitis C Medicaid Access Ranking: B+

  • No liver damage restrictions
  • Requires one-month sobriety before beginning treatment or documentation that patient is receiving counseling
    • For patients who have had treatment before, three months of sobriety is required
  • No prescriber requirements
  • Resource

  • Hepatitis C Medicaid Access Ranking: C+

  • No liver damage restrictions
  • Peach State Health Plan and CareSource do not have any public information about coverage criteria
  • Fee-For-Service and AmeriGroup require patients to be in a substance use program if they use alcohol and drugs
  • No prescriber requirements
  • Consistency of criteria amongst managed care organizations is unclear
  • Resource

  • Hepatitis C Medicaid Access Ranking: B

  • No liver damage restrictions
  • Kaiser Permanente does not have public information about coverage criteria
  • Providers need to evaluate alcohol use and urine toxicology results prior to treatment initiation
    • AlohaCare: no sobriety restriction
  • A specialist must write the prescription for treatment
    • Ohana Health Plan and UnitedHealthcare Community Plan requires a specialist or primary care physician to prescribe treatment
  • Consistency of criteria amongst managed care organizations is unclear
  • Resource

  • Hepatitis C Medicaid Access Ranking: A-

  • No liver damage restrictions
  • Providers must consider counseling for patients with substance use disorders
  • Authorization from providers about Medication-Assisted Treatment is required to treat opioid use disorder concurrently with hepatitis C
  • No prescriber restrictions
  • Resource

  • Hepatitis C Medicaid Access Ranking: B-

  • No liver damage restrictions
  • Requires screening for substance use
  • Providers need to attest that they will treat the alcohol or drug misuse of their patients
    • Aetna Better Health requires three months of sobriety from alcohol and drugs before treatment
  • Requires a specialist to prescribe treatment
    • Molina does not impose prescriber requirements
  • Meridan Health Plan, CountyCare Health Plan, and YouthCare do not publicly disclose coverage criteria
  • Consistency of criteria amongst managed care organizations is unclear
  • Resource

  • Hepatitis C Medicaid Access Ranking: B-

  • No liver damage restrictions
  • No sobriety restrictions
  • No prescriber restrictions
  • “Indiana has streamlined treatment access by not requiring prior authorization for treatment naïve individuals”
  • Resource

  • Hepatitis C Medicaid Access Ranking: C

  • No liver damage restrictions
  • Three months sobriety from alcohol and substance use is required before treatment initiation, sobriety needs to be confirmed by a urine screen
  • Requires a liver, infectious disease, or digestive disease specialist to prescribe treatment
  • Resource

  • Hepatitis C Medicaid Access Ranking: C

  • No liver damage restrictions
  • Three months sobriety from alcohol and substance use is required before treatment initiation, sobriety needs to be confirmed by a urine screen
  • Requires a liver, infectious disease, or digestive disease specialist to prescribe treatment
  • Resource

  • Hepatitis C Medicaid Access Ranking: C

  • No liver damage restrictions
  • No sobriety restrictions
  • A gastroenterologist, hepatologist, or infectious disease specialist is required to prescribe treatment if the patient has received hepatitis C treatment previously
  • Resource

  • Hepatitis C Medicaid Access Ranking: A-

  • No liver damage or fibrosis restrictions
  • No sobriety treatments for patients who have never been to treatment before
    • For patients who have been to treatment before, participating in a substance use treatment program and testing negative on a urine toxicology screen is required.
  • No prescriber restrictions for individuals in simplified treatment
    • A prescription for treatment from a specialist or a provider in HCV training program or network is required for patients who have been treated for hepatitis C before or for patients with comorbidities.
  • Certain criteria is needed to receive simplified treatment
    • Criteria includes: previously treated for hepatitis C, cirrhosis, HIV+, HBV+, history of liver transplant, or hepatocellular carcinoma.
  • Resource

  • Hepatitis C Medicaid Access Ranking: A+

  • No liver damage restrictions
  • No sobriety restrictions
  • No prescriber restrictions
  • Resource

  • Hepatitis C Medicaid Access Ranking: B+

  • No liver damage restrictions
  • No sobriety restrictions
  • NNo prescriber restrictions for patients who qualify for simplified treatment
    • A prescription by a specialist is required for patients with certain conditions:
      • Conditions include: prior hepatitis C treatment, cirrhosis, HIV, hepatitis B surface antigen position, current pregnancy, known or suspected hepatocellular carcinoma, or prior liver transplantation
    • Resource

  • Hepatitis C Medicaid Access Ranking: A-

  • No liver damage restrictions
    • Priority Partners, a managed care organization, have unclear liver damage restrictions
  • No sobriety restrictions
    • Priority Partners require a screening for alcohol and substance use
  • Most managed care organizations require providers and patients make treatment plans for hepatitis C
    • Kaiser Permanente require a prescription by a specialist
    • Priority Partners have unclear restrictions
  • Resource

  • Hepatitis C Medicaid Access Ranking: A

  • No liver damage restrictions
  • No sobriety restrictions
  • No prescriber restrictions
  • Resource

  • Hepatitis C Medicaid Access Ranking: A+

  • No liver damage restrictions
  • No sobriety restrictions
  • No prescriber restrictions
  • Resource

  • Hepatitis C Medicaid Access Ranking: A-

  • No liver damage restrictions
  • Require screening and counseling for substance use
  • Primary care physicians can prescribe treatment
    • A specialist is required to prescribe when the patient has had treatment before, has HIV, has hepatitis B, has undergone a liver transplant, has liver cancer or severe liver disease
  • Resource

  • Hepatitis C Medicaid Access Ranking: D+

  • No liver damage restrictions
  • Require 6 months of sobriety and a negative urine toxicology screen for patients with a history of substance use
  • Require a specialist to consult or prescribe treatment
  • Resource

  • Hepatitis C Medicaid Access Ranking: A+

  • No liver damage restrictions
  • No sobriety restrictions
  • No prescriber restrictions
  • Resource

  • Hepatitis C Medicaid Access Ranking: A-

  • No liver damage restrictions
  • Counseling and a screening are required for patients who misuse drugs and alcohol
  • No prescriber restrictions
  • Resource

  • Hepatitis C Medicaid Access Ranking: B-

  • No liver damage restrictions
  • Requires six months sobriety or evidence of participating in a treatment program to get treatment
  • No prescriber restrictions
  • Resource

  • Hepatitis C Medicaid Access Ranking: B

  • No liver damage restrictions
    • Two managed care organizations, Health Plan of Nevada and SilverSummit, do not disclose Hepatitis C coverage criteria
    • It is unclear whether Molina has liver damage restrictions
  • No sobriety restrictions
    • Two managed care organizations, Health Plan of Nevada and SilverSummit, do not disclose Hepatitis C coverage criteria
  • Fee-For-Service and Molina require a specialist to prescribe treatment.
    • Anthem: no prescriber requirements
    • Two managed care organizations, Health Plan of Nevada and SilverSummit, do not disclose Hepatitis C coverage criteria
  • Resource

  • Hepatitis C Medicaid Access Ranking: B+

  • No liver damage restrictions
  • Fee-For-Service and AmeriHealth require prescriber to screen for alcohol and drug use during treatment
    • Healthy Families and Well Sense do not have sobriety restrictions
  • Fee-For-Service, AmeriHealth, and Healthy Families require a specialist or a prescriber with hepatitis C education to prescribe treatment
    • Well Sense does not have prescriber restrictions
  • Resource

  • Hepatitis C Medicaid Access Ranking: B

  • No liver damage restrictions
  • No sobriety restrictions
    • One managed care organization, WellCare, requires a negative urine toxicology result and requires counseling for patients with substance use disorder
  • No prescriber restrictions
    • UnitedHealthcare Community Plan requires a specialist to prescribe treatment
    • Horizon NJ Health and WellCare have unclear requirements
  • Resource

  • Hepatitis C Medicaid Access Ranking: A

  • No liver damage restrictions
  • No sobriety restrictions
  • No prescriber restrictions
    • Western Sky Community Care requires a specialist to prescribe treatment
  • Resource

  • Hepatitis C Medicaid Access Ranking: A-

  • No liver damage restrictions
  • No sobriety restrictions
  • No prescriber restrictions
    • VNSNY Choice Health Plans and MetroPlus Health Plans require a specialist or a HCV treatment-experience provider to prescribe treatment
  • Resource

  • Hepatitis C Medicaid Access Ranking: A

  • No liver damage restrictions
  • No sobriety restrictions
  • No prescriber restrictions
  • Resource

  • Hepatitis C Medicaid Access Ranking: C+

  • No liver damage restrictions
  • Requires three months of abstinence from alcohol and injection drug use proven by two drug and alcohol screening tests
  • Requires a specialist to prescribe treatment
    • Primary care providers can prescribe treatment for patients who have not received treatment before
  • Resource

  • Hepatitis C Medicaid Access Ranking: B+

  • No liver damage restrictions
  • No sobriety restrictions
  • A hepatologist, gastroenterologist, or infectious disease specialist is required to prescribe treatment
  • Resource

  • Hepatitis C Medicaid Access Ranking: C

  • No liver damage restrictions
  • No sobriety restrictions
  • A screening and counseling is required for alcohol and substance use
  • The patient must commit to abstain from alcohol and substance use during and after treatment and agree to random drug testing during treatment
  • A gastroenterologist, infectious disease, or transplant specialist must prescribe treatment
  • Resource

  • Hepatitis C Medicaid Access Ranking: A-

  • No liver damage restrictions
    • Yamhill Community Care does not publicly disclose hepatitis C coverage criteria
  • No sobriety restrictions
    • Yamhill Community Care does not publicly disclose hepatitis C coverage criteria
  • No prescriber restrictions except for cases of cirrhosis; a specialist is required to prescribe treatment for patients with cirrhosis
    • InterCommunity Health Network CCO: hepatologist, gastroenterologist, or infectious disease specialist to prescribe treatment
    • Yamhill Community Care does not publicly disclose hepatitis C coverage criteria
  • Resource

  • Hepatitis C Medicaid Access Ranking: A-

  • No liver damage restrictions
    • UnitedHealthcare does not publicly disclose hepatitis C coverage criteria
  • No sobriety restrictions
    • UnitedHealthcare does not publicly disclose hepatitis C coverage criteria
  • No prescriber restrictions except for cases of cirrhosis; a specialist is required to prescribe treatment for patients with cirrhosis
    • UPMC For You requires a specialist to prescribe treatment
    • UnitedHealthcare does not publicly disclose hepatitis C coverage criteria
  • Resource

  • Hepatitis C Medicaid Access Ranking: A

  • No liver damage restrictions
  • No sobriety restrictions
  • Primary care physicians prescribe treatment
  • Resource
  • Spanish State Report

  • Hepatitis C Medicaid Access Ranking: A+

  • No liver damage restrictions
  • No sobriety restrictions
  • No prescriber restrictions
  • Resource

  • Hepatitis C Medicaid Access Ranking: D

  • No liver damage restrictions
    • Three managed care organizations, Absolute Total Care, Humana Healthy Horizons, and Molina Healthcare do not publicly disclose hepatitis C coverage criteria
  • Fee-For-Service requires six months sobriety from alcohol and substances
    • First Choice requires the provider to attest they “provided substance use counseling and offered referral for substance use disorder treatment”
    • Healthy Blue does not appear to have sobriety restrictions
    • Three managed care organizations, Absolute Total Care, Humana Healthy Horizons, and Molina Healthcare do not publicly disclose hepatitis C coverage criteria
  • A gastroenterologist, infectious disease, or hepatology specialist is needed to prescribe treatment
    • Healthy Blue does not have prescriber restrictions
    • Three managed care organizations, Absolute Total Care, Humana Healthy Horizons, and Molina Healthcare do not publicly disclose hepatitis C coverage criteria
  • Resource

  • Hepatitis C Medicaid Access Ranking: D-

  • Requires a fibrosis score of F2 or greater for treatment
  • Six months of sobriety from alcohol and drugs is required for treatment
  • A specialist must prescribe treatment
  • Resource

  • Hepatitis C Medicaid Access Ranking: B-

  • No liver damage restrictions
  • Requires either six months of sobriety for patients with histories of alcohol or drug use, or confirmation from a prescriber that the patient has received treatment for substance use disorder through a recovery program or counseling
  • Any physician can prescribe treatment
    • Except for patients with decompensated cirrhosis, history of HIV, co-infection with hepatitis B, or have received treatment for HCV before)
    • In these cases, a specialist would need to prescribe treatment
  • Resource

  • Hepatitis C Medicaid Access Ranking: A

  • No liver damage restrictions
  • No sobriety restrictions
  • No prescriber restrictions
  • Resource

  • Hepatitis C Medicaid Access Ranking: C

  • Some managed care organizations and Fee-For-Service (FFS) do not have liver damage restrictions
    • SelectHealth Community Care requires moderate liver damage (F2 or greater)
    • Health Choice Utah requires severe liver damage (F3 or greater)
  • FFS has no sobriety restrictions
    • SelectHealth Community Care requires six months of sobriety
    • Health Choice Utah, Healthy U, and Molina Healthcare of Utah require screening and some form of counseling
  • FFS requires a specialist to prescribe treatment for patients who have received hepatitis C treatment before
    • Molina Healthcare of Utah: no prescriber restrictions
    • Healthy U, SelectHealth Community Care, and Health Choice Utah require a specialist to prescribe treatment
  • Resource

  • Hepatitis C Medicaid Access Ranking: A-

  • No liver damage restrictions
  • No sobriety restrictions
  • Any physician can prescribe treatment
    • Except for patients who have had hepatitis C treatment before, have cirrhosis, have HIV, have hepatitis B, are currently pregnant, have liver cancer, or had a liver transplantation before.
    • In these cases, a specialist is required to prescribe treatment
  • Resource

  • Hepatitis C Medicaid Access Ranking: A

  • No liver damage restrictions
  • No sobriety restrictions
  • No prescriber restrictions for preferred drugs
    • For other drugs (or non-preferred drugs), a specialist is required to prescribe
  • Resource

  • Hepatitis C Medicaid Access Ranking: A+

  • No liver damage restrictions
  • No sobriety restrictions
  • No prescriber restrictions
  • Resource

  • Hepatitis C Medicaid Access Ranking: C+

  • No liver damage restrictions
  • Require three months of sobriety from alcohol and drugs
  • Requires a specialist to prescribe treatment
  • Resource

  • Hepatitis C Medicaid Access Ranking: A+

  • No liver damage restrictions
  • No sobriety restrictions
  • No prescriber restrictions
  • Resource

  • Hepatitis C Medicaid Access Ranking: B+

  • No liver damage restrictions
  • Requires a drug screening within 30 days of treatment
    • Requires additional information prior to authorization in the case of a positive drug screen test
  • No prescriber restrictions
  • Resource