MedicaidPrior AuthMedium impact
Hepatitis C Direct Acting Antiviral Criteria Update
Illinois Medicaid - HFS·IL · Gastroenterology, Infectious Disease, Internal Medicine +1 more·Provider Notice
Effective date
Nov 1, 2018
We identified it
Jun 20, 2026
Summary
Illinois Medicaid has eliminated Metavir score requirements for Hepatitis C Direct Acting Antiviral (DAA) therapy coverage, effective November 1, 2018. Providers can now obtain prior authorization for DAA therapy regardless of patient's liver fibrosis stage, significantly expanding treatment eligibility.
Action Required
Immediately: Review existing Hepatitis C patients who were previously denied DAA therapy due to low Metavir scores and resubmit prior authorization requests using current form. Monitor HFS Drug Prior Approval Criteria and Forms webpage for updated DAA Prior Authorization Request Form and implement when available. Update internal protocols to remove Metavir score restrictions for Hepatitis C treatment approvals.