Recent advancements in Hepatitis C treatment regimens have enhanced the ability of health care providers to decrease the spread of Hepatitis C Viral (HCV) infection and prevent chronic liver disease. These developments are especially significant among those dually infected with HIV.
To mitigate the transmission and morbidity associated with HCV, especially among those dually infected with HIV, the Illinois Ryan White Part B AIDS Drug Assistance Program (ADAP) added five Hepatitis C medications to the Illinois ADAP formulary effective February 10, 2016. These new additions include Harvoni (ledipasvir/sofosbuvir), Viekira Pak, Sovaldi (sofosbuvir), Ribavirin, and Zepatier.
Illinois Department of Public Health will be measuring the utilization, adoption and prior authorization process of administering these medications to an initial subset of 100 eligible, dually infected patients, as outlined below. This trial expansion will help determine the sustainability of these medications for the ADAP program as payer of last resort. These new HCV medications will be available to ADAP eligible clients after completion of a required Hepatitis C prior approval form from the Department.
Medical providers should note that treatment for HCV, among patients where treatment is medically indicated, is a 12-, 16- or 24-week regimen. Hepatitis C medications will not count toward the $2,000 dollar monthly benefit cap. Specific prescribing guidelines can be found in the Hepatitis C prior approval form and the Illinois ADAP Formulary.
To be eligible for coverage under ADAP, clients must meet the following:
- Be currently enrolled in ADAP or eligible for ADAP assistance for the full duration of treatment
- Documentation of HCV infection with a Fibrosis Stage 2 (F2) and above
- Have documentation of denial of medication coverage by their insurance plan (if applicable)
- For Zepatier: If Genotype 1a, need baseline NS5A resistance test and documentation
- Medical Provider must attest they have reviewed the Manufacturers’ Prescribing Guidelines for possible drug interactions and contraindications associated with prescription of these medications in conjunction with the client’s current HIV regimen.
If there are any questions, please do not hesitate to call the ADAP Office at 1-800-825-3518 or email the Ryan White Part B ADAP Administrator at Jeffrey.firstname.lastname@example.org.