Apple Health (Medicaid) coverage for people with HCV and SUD

Washington State Health Care Authority sent this bulletin at 02/22/2024 08:00 AM PST

February 22, 2024

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Letter on State Medicaid Coverage for people with HCV and SUD

The US Department of Justice issued a letter to all State Medicaid Administrators January 24 encouraging the administrators to ensure patients with both Hepatitis C (HCV) and substance use disorder (SUD) have access to direct-acting antivirals.

Washington State Apple Health (Medicaid) already has policies in place to treat patients with both HCV and SUD. The direct-acting antiviral drug Mavyret^TM to treat HCV is preferred and sobriety is not required. Anyone licensed to prescribe is allowed to screen and treat Apple Health members for HCV.

To eliminate HCV in Washington, the Health Care Authority encourages all providers to do the following:

Test all adults 18 years and older at least once.
Test all pregnant women during each pregnancy.
Regularly screen patients with risk factors, including people who inject drugs.
Reach out to patients who have tested positive but have no history of treatment.

Read the letter

Apple Health coverage and policy

Drug (treatment)	Policy
Mavyret (HCV)	Preferred No prior authorization No sobriety requirement No liver biopsy or imaging required
Buprenorphine - SUD	Preferred No prior authorization
Naltrexone - SUD	Preferred No prior authorization
Naloxone - SUD	Preferred No prior authorization

More information

Visit the Health Care Authority's eliminating hepatitis C page for more information.

If you have questions about drug coverage on the Apple Health preferred drug list, follow these instructions:

Go to HCA Support.
Click Public. You will need a SecureAccess Washington (SAW) account. (View instructions for accessing SAW.)
Once you have logged into SAW, you will see the HCA Support portal.
Click Make a Request.
Click the Apple Health Pharmacy tile. This will take you to the online form.

About the Health Care Authority (HCA)

Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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Nondiscrimination

The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.