Hepatitis C, cystic fibrosis medications now available

Medicaid recipients in Michigan now have coverage for new medications to treat hepatitis C and cystic fibrosis as of March 1.

A new class of drugs to treat hepatitis C and another to treat cystic fibrosis will be covered for patients who meet criteria.

As with most states, Michigan is initiating coverage with hepatitis C direct-acting antiviral drugs such as Sovaldi for those most severely affected -— individuals with chronic hepatitis C and advanced liver disease. Orkambi now will be covered for people with cystic fibrosis who have two copies of the F508del mutation to correct the function of a defective protein made by the cystic fibrosis gene.

Michigan Senate and House Appropriations subcommittees in January authorized spending transfers needed to cover the medications. Gov. Rick Snyder’s executive budget recommendations for fiscal years 2016 and 2017 include additional funds to pay those costs.

The Michigan Department of Health and Human Services decided to begin providing coverage for the drugs upon recommendation of its Pharmacy and Therapeutics Committee.

The prescriptions will be available through Medicaid prior authorization to all eligible beneficiaries enrolled in Michigan Medicaid, Healthy Michigan Plan, Children’s Special Health Care Services and other waiver programs. Prior authorization is the process of reviewing a medication against criteria prior to Michigan Medicaid covering the drug.

A patient’s doctor can obtain prior authorization by submitting a request form located at https://michigan.fhsc.com/Providers/Forms.asp. Once the request is reviewed and approved, the pharmacy can fill the prescription for these new medications for coverage by Medicaid.

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