MedicaidCoverageMedium impact
Hepatitis C Treatment
Illinois Medicaid - HFS·IL · Gastroenterology, Infectious Disease, Internal Medicine +1 more·Provider Notice
Effective date
Oct 1, 2016
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now covers direct-acting antivirals (DAAs) for Hepatitis C treatment at earlier disease stages (F3 instead of F4) effective October 1, 2016. All Hepatitis C drugs still require prior authorization for Medicaid reimbursement.
Action Required
Billing team must ensure prior authorization is obtained for all Hepatitis C DAA prescriptions for Illinois Medicaid patients with Metavir score F3 or higher. Download updated prior authorization forms from HFS Criteria and Forms webpage. Contact Bureau of Professional and Ancillary Services at 1-877-782-5565 for questions about criteria.