MedicaidPrior AuthMedium impact
Provider Letter 2022-20: Re: Mavyret® (Glecaprevir/Pibrentasvir) Update
Oklahoma SoonerCare·OK · Gastroenterology, Infectious Disease, Internal Medicine +1 more·Provider Letter
Effective date
Sep 13, 2022
We identified it
Jun 20, 2026
Summary
Oklahoma Medicaid (SoonerCare) has removed prior authorization requirements for Mavyret® (glecaprevir/pibrentasvir) for hepatitis C treatment, effective immediately. All other direct-acting antiviral medications for hepatitis C still require prior authorization with patient-specific clinical justification.
Action Required
Immediately: Billing team must update prior authorization workflows to remove PA requirements for Mavyret® (glecaprevir/pibrentasvir) prescriptions for SoonerCare members with hepatitis C. Update authorization tracking systems to reflect that Mavyret® no longer requires PA while all other DAA medications still require the three-form PA process (medication-specific PA, Pharm-28, and Pharm-29 forms).