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August 2022
Effective immediately, Mavyret® (glecaprevir/pibrentasvir) is SoonerCare’s only preferred direct-acting antiviral (DAA) medication for HCV, and is now available without prior authorization (PA) as part of an initiative by OHCA to cure HCV in the SoonerCare population.
Mavyret® is FDA approved to treat adult and pediatric patients ages 3 years and older with chronic HCV genotype (GT) 1, 2, 3, 4, 5, or 6 infection without cirrhosis or with compensated cirrhosis (Child-Pugh A). It is also approved to treat HCV GT 1 infection in patients who have been previously treated with a regimen that contained an HCV NS5A inhibitor or an HCV NS3/4A protease inhibitor, but not both.
The American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society of America (IDSA) have developed HCV treatment guidelines. Prescribers are encouraged to follow these guidelines and Mavyret® prescribing information when initiating testing for HCV, selecting an appropriate treatment regimen and performing all necessary monitoring. As for all HCV treatment, patients should be monitored for compliance and counseled regarding the importance of compliance and finishing treatment.
Mavyret® is the only DAA available without PA. The PA criteria is still effective and PA forms are still required for other DAAs. PA requests for other DAAs will also require a patient-specific, clinically significant reason why the member cannot use Mavyret®. The specific PA requirements are located on the OHCA website at www.oklahoma.gov/ohca/pa in the “Hepatic Disorders” therapeutic category. Initial PA requests for all other DAAs besides Mavyret® must be submitted using all 3 PA forms:
- The medication-specific PA form (e.g., Harvoni®, Pharm-33)
- Hepatitis C Therapy Intent to Treat Contract form (i.e., Pharm-28)
- Hepatitis C Therapy Pharmacy Agreement form (i.e., Pharm-29)
Continuation requests (for each refill) must be submitted using the Hepatitis C Therapy Continuation form (i.e., Pharm-30). The PA forms are located on the OHCA website at https://oklahoma.gov/ohca/rxforms.
In an effort to reduce the number of opioid prescriptions for back pain, OHCA implemented alternative treatments for pain management effective January 1, 2022, consisting of coverage for chiropractic care for adults ages 21 years and older.
A Guide for SoonerCare Chiropractors has been published to the provider training page to help chiropractors become familiar with coverage, contracting requirements, verifying SoonerCare member eligibility and prior authorization for services. Additionally, a chiropractors and SoonerCare webinar recording is available to view with the respective Q&A document on the provider training page under the Previous Webinars section of the page.
For any questions, please call the OHCA provider helpline at 800-522-0114 or email SoonerCareEducation@okhca.org.
Have you heard a member story that is too good not to share? We would love to share it with our members and other stakeholders. Send the details to the Strategic Communications team at strategiccommunications@okhca.org. This story could be shared on social media, in emails and other communications!
The free COVID tests that were made available by mail are ending next week. However, SoonerCare members can still get these FDA authorized tests from pharmacies per our disaster relief state plan amendment. A global message was sent to all providers on January 28, 2022. Here is a link to more information on our website: COVID Test Fax Blast-final.pdf (oklahoma.gov)
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