Hepatitis C Virus (HCV) Direct-Acting Antiviral (DAA) Agents

Pharmacy Policy Memo

• Louisiana Fee for Service (FFS) Medicaid and Managed Care Organizations (MCOs) Hepatitis C Virus (HCV) Direct-Acting Antiviral (DAA) Agents Clinical Prior and Pre-Authorization Criteria Revision

Managed Care Organizations (MCOs) and Fee for Service (FFS) Medicaid Hepatitis C Virus Direct-Acting Antiviral Agents Treatment Criteria & Forms

• Aetna
• AmeriHealth Caritas
• Fee for Service
• Healthy Blue
• LA Healthcare Connections
• United Healthcare