MedicaidPrior AuthMedium impact
Supplement 24-06: Repeal of Hepatitis C Virus (HCV) Checklist – and Elimination of Prior Authorization for Glecaprevir/Pibrentasivir (Mavyret®) and Sofosbuvir/Velpatasvir (Epclusa ®) Replaces Supplement 20-13
New Mexico Medicaid·NM · Gastroenterology, Infectious Disease, Internal Medicine +1 more·Prior Authorization
Effective date
May 14, 2024
We identified it
Jun 21, 2026
Summary
New Mexico Medicaid has eliminated prior authorization requirements for two Hepatitis C medications (Mavyret® and Epclusa®) and repealed the mandatory HCV Checklist form (MAD 634). These medications can now be prescribed without prior authorization for both Fee-For-Service and Managed Care Organization members.
Action Required
Immediately: Billing team should update systems to remove prior authorization requirements for glecaprevir/pibrentasivir (Mavyret®) and sofosbuvir/velpatasvir (Epclusa®) for New Mexico Medicaid members. Stop using MAD 634 'Uniform New Mexico HCV Checklist' form for HCV treatment requests. Continue using MAD 635 'Drug Prior Authorization Form' for other HCV medications not specified in this update.