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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

August 2016

Updated Coverage Criteria for Hepatitis C Drugs


Harvard Pilgrim is updating its clinical coverage criteria regarding medications indicated for the treatment of hepatitis C. Effective September 1, 2016, patients will no longer need to demonstrate fibrosis levels of F2 or greater in order to be approved for the use of hepatitis C medications.

Clinical coverage criteria documents and medication request forms for hepatitis C drugs covered by Harvard Pilgrim are being updated to remove this criterion; the updated documents will be posted here as of the September 1 effective date. Harvard Pilgrim will continue to require prior authorization for these medications — such as Harvoni — but will not restrict coverage based on fibrosis scores.

Harvard Pilgrim is making this change to align with the American Association for the Study of Liver Diseases’ (AASLD’s) guidelines for professional medical organizations. You can find the Medication Request Forms and Clinical Coverage Criteria for these drugs, which will be updated as of September 1.

For more information, please visit Harvard Pilgrim’s pharmacy webpage.

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PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator