Hepatitis C - Revision history

LiamG at 19:47, 16 September 2025

2025-09-16T19:47:22Z

← Older revision		Revision as of 19:47, 16 September 2025
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	Adults with hepatitis C (any genotype) who do NOT have cirrhosis or have compensated cirrhosis (Child-Turcotte-Pugh (CTP) score < 6) and persons who have not previously received HCV treatment are eligible for simplified treatment pathway.		Adults with hepatitis C (any genotype) who do NOT have cirrhosis or have compensated cirrhosis (Child-Turcotte-Pugh (CTP) score < 6) and persons who have not previously received HCV treatment are eligible for simplified treatment pathway.

	Patients who have any of the following are not eligible:		Patients who have any of the following are not eligible and need consultation with a liver disease specialist:

	* Prior HCV treatment		* Prior HCV treatment
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	* Known or suspected hepatocellular carcinoma		* Known or suspected hepatocellular carcinoma
	* Prior liver transplantation		* Prior liver transplantation
			Step 1: Determine FIB-4 Score and Assess for Cirrhosis and proceed if FIB-4 < 3.25 without cirrhosis or CTP < 7 with cirrhosis.
	Step 1: Determine FIB-4 Score and Assess for Cirrhosis and proceed if FIB-4 < 3.25 without cirrhosis or CTP < 7 with cirrhosis.

	Step 2: Pre-treatment Labs and Assessment.		Step 2: Pre-treatment Labs and Assessment.
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	Step 3: Treat.		Step 3: Treat.

	~~-- determining YKHC formulary for rx -- 9~~/16/~~2025~~		* Glecaprevir/Pibrentasvir (Mavyret™) 3 tablets daily x 8 weeks, or
			* Sofosbuvir/Velpatasvir (Epclusa®) 1 tablet daily x 12 weeks

			As decided by P&T committee April 24, 2019, all hepatitis C medications will be treated as an "open formulary.”

			Pharmacy will not routinely stock the medications, but will order in the medication when it is prescribed without a non-formulary request needing to be filled out.

			Some private insurances will require prior authorization.
	===Resources/References===		===Resources/References===
	*Adapted from [https://anthc.org/community-health/wellness/#hep ANTHC Liver Disease and Hepatitis Program.]		*Adapted from [https://anthc.org/community-health/wellness/#hep ANTHC Liver Disease and Hepatitis Program]
			*American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society of America (IDSA) [https://www.hcvguidelines.org/treatment-naive/simplified-treatment Simplified HCV Treatment for Treatment-Naive Adults Without Cirrhosis]
			*AASLD and IDSA [https://www.hcvguidelines.org/treatment-naive/simplified-treatment-compensated-cirrhosis Simplified HCV Treatment Algorithm for Treatment-Naive Adults With Compensated Cirrhosis]



	[[Practicing Medicine in Bush Alaska—Some ABCs\|Common/Unique Medical Diagnoses]]		[[Practicing Medicine in Bush Alaska—Some ABCs\|Common/Unique Medical Diagnoses]]

LiamG at 18:15, 16 September 2025

2025-09-16T18:15:12Z

@@ Line 1: / Line 1: @@
-Anyone with untreated Hepatitis C (HCV) can be given glecaprevir/pibrentasvir (Mavyret™) for 8 weeks.
-Please call the ANMC Hepatology team with any questions and see the Resources below for a link to the Prior Authorization Form.
+Patients who have any of the following are not eligible:
-If a patient is to be started on glecaprevir/pibrentasvir, the [http://dhss.alaska.gov/dhcs/Documents/pharmacy/forms/AK_Hep_C_DAA_Fax_Form_20171001.pdf medication prior authorization form] needs to be filled out by BOTH patient and provider prior to the medication being dispensed. It is ideal to have this form completed during the visit and given to your clinic pharmacist when sending the prescription to the pharmacy.
+* Prior HCV treatment
 ===Resources/References===
-*[https://www.anthc.org/wp-content/uploads/2022/05/Treatment-Checklist-Simplified.pdf Simplified Hepatitis C Treatment Checklist - ANTHC 2022]
+*Adapted from [https://anthc.org/community-health/wellness/#hep ANTHC Liver Disease and Hepatitis Program.]
-*[https://www.anthc.org/what-we-do/clinical-and-research-services/hep/hep-c-treatment-information/ Hepatitis C Treatment Webpage - ANTHC 2022]
 [[Practicing Medicine in Bush Alaska—Some ABCs|Common/Unique Medical Diagnoses]]

LiamG: /* Resources/References */

2024-01-26T10:31:01Z

Resources/References

← Older revision		Revision as of 10:31, 26 January 2024
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	Anyone with untreated Hepatitis C can be given glecaprevir/pibrentasvir (Mavyret™) for 8 weeks. Please call the ANMC Hepatology team with any questions and see the Resources below for a link to the Prior Authorization Form.		Anyone with untreated Hepatitis C (HCV) can be given glecaprevir/pibrentasvir (Mavyret™) for 8 weeks.

			Please call the ANMC Hepatology team with any questions and see the Resources below for a link to the Prior Authorization Form.

			If a patient is to be started on glecaprevir/pibrentasvir, the [http://dhss.alaska.gov/dhcs/Documents/pharmacy/forms/AK_Hep_C_DAA_Fax_Form_20171001.pdf medication prior authorization form] needs to be filled out by BOTH patient and provider prior to the medication being dispensed. It is ideal to have this form completed during the visit and given to your clinic pharmacist when sending the prescription to the pharmacy.

	If a patient is to be started on glecaprevir/pibrentasvir, the [http://dhss.alaska.gov/dhcs/Documents/pharmacy/forms/AK_Hep_C_DAA_Fax_Form_20171001.pdf medication prior authorization form] needs to be filled out by BOTH patient and provider prior to the medication being dispensed. It is ideal to have this form completed during the visit and given to your clinic pharmacist when sending the Rx to the pharmacy.


	===Resources/References===		===Resources/References===
	*[https://www.anthc.org/what-we-do/clinical-and-research-services/hep/hep-c-treatment-information/~~\| ANTHC~~ Hepatitis C Treatment ~~Information~~]		*[https://www.anthc.org/wp-content/uploads/2022/05/Treatment-Checklist-Simplified.pdf Simplified Hepatitis C Treatment Checklist - ANTHC 2022]
			*[https://www.anthc.org/what-we-do/clinical-and-research-services/hep/hep-c-treatment-information/ Hepatitis C Treatment Webpage - ANTHC 2022]
	*[http://dhss.alaska.gov/dhcs/Documents/pharmacy/forms/AK_Hep_C_DAA_Fax_Form_20171001.pdf Alaska Medicaid Prior Authorization Form Hepatitis C Direct Acting Antivirals – New Starts]		*[http://dhss.alaska.gov/dhcs/Documents/pharmacy/forms/AK_Hep_C_DAA_Fax_Form_20171001.pdf Alaska Medicaid Prior Authorization Form Hepatitis C Direct Acting Antivirals – New Starts]
	* [[~~media~~:Liver Disease Updates 10.6.17.pdf\|Liver Disease Updates 2017]] (PowerPoint Presentation)		* [[Media:Liver Disease Updates 10.6.17.pdf\|Liver Disease Updates 2017]] (PowerPoint Presentation)
	* [[~~media~~:Hep C Update 2015.pdf\|Hepatitis C Update 2015]] (PowerPoint Presentation)		* [[Media:Hep C Update 2015.pdf\|Hepatitis C Update 2015]] (PowerPoint Presentation)


	[[Practicing Medicine in Bush Alaska—Some ABCs\|Common/Unique Medical Diagnoses]]		[[Practicing Medicine in Bush Alaska—Some ABCs\|Common/Unique Medical Diagnoses]]

LiamG at 13:58, 2 August 2023

2023-08-02T13:58:11Z

← Older revision		Revision as of 13:58, 2 August 2023
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	If a patient is to be started on glecaprevir/pibrentasvir, the [http://dhss.alaska.gov/dhcs/Documents/pharmacy/forms/AK_Hep_C_DAA_Fax_Form_20171001.pdf medication prior authorization form] needs to be filled out by BOTH patient and provider prior to the medication being dispensed. It is ideal to have this form completed during the visit and given to your clinic pharmacist when sending the Rx to the pharmacy.		If a patient is to be started on glecaprevir/pibrentasvir, the [http://dhss.alaska.gov/dhcs/Documents/pharmacy/forms/AK_Hep_C_DAA_Fax_Form_20171001.pdf medication prior authorization form] needs to be filled out by BOTH patient and provider prior to the medication being dispensed. It is ideal to have this form completed during the visit and given to your clinic pharmacist when sending the Rx to the pharmacy.

LiamG at 13:58, 2 August 2023

2023-08-02T13:58:01Z

← Older revision		Revision as of 13:58, 2 August 2023
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	If a patient is to be started on glecaprevir/pibrentasvir, the [http://dhss.alaska.gov/dhcs/Documents/pharmacy/forms/AK_Hep_C_DAA_Fax_Form_20171001.pdf medication prior authorization form] needs to be filled out by BOTH patient and provider prior to the medication being dispensed. It is ideal to have this form completed during the visit and given to your clinic pharmacist when sending the Rx to the pharmacy.		If a patient is to be started on glecaprevir/pibrentasvir, the [http://dhss.alaska.gov/dhcs/Documents/pharmacy/forms/AK_Hep_C_DAA_Fax_Form_20171001.pdf medication prior authorization form] needs to be filled out by BOTH patient and provider prior to the medication being dispensed. It is ideal to have this form completed during the visit and given to your clinic pharmacist when sending the Rx to the pharmacy.

	~~[https://www.anthc.org/what-we-do/clinical-and-research-services/hep/hep-c-treatment-information/\| ANTHC Hepatitis C Treatment Information]~~

	===Resources/References===		===Resources/References===
			*[https://www.anthc.org/what-we-do/clinical-and-research-services/hep/hep-c-treatment-information/\| ANTHC Hepatitis C Treatment Information]
	*[http://dhss.alaska.gov/dhcs/Documents/pharmacy/forms/AK_Hep_C_DAA_Fax_Form_20171001.pdf Alaska Medicaid Prior Authorization Form Hepatitis C Direct Acting Antivirals – New Starts]		*[http://dhss.alaska.gov/dhcs/Documents/pharmacy/forms/AK_Hep_C_DAA_Fax_Form_20171001.pdf Alaska Medicaid Prior Authorization Form Hepatitis C Direct Acting Antivirals – New Starts]
	* [[media:Liver Disease Updates 10.6.17.pdf\|Liver Disease Updates 2017]] (PowerPoint Presentation)		* [[media:Liver Disease Updates 10.6.17.pdf\|Liver Disease Updates 2017]] (PowerPoint Presentation)

LiamG at 13:55, 2 August 2023

2023-08-02T13:55:05Z

← Older revision		Revision as of 13:55, 2 August 2023
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	If a patient is to be started on glecaprevir/pibrentasvir, the [http://dhss.alaska.gov/dhcs/Documents/pharmacy/forms/AK_Hep_C_DAA_Fax_Form_20171001.pdf medication prior authorization form] needs to be filled out by BOTH patient and provider prior to the medication being dispensed. It is ideal to have this form completed during the visit and given to your clinic pharmacist when sending the Rx to the pharmacy.		If a patient is to be started on glecaprevir/pibrentasvir, the [http://dhss.alaska.gov/dhcs/Documents/pharmacy/forms/AK_Hep_C_DAA_Fax_Form_20171001.pdf medication prior authorization form] needs to be filled out by BOTH patient and provider prior to the medication being dispensed. It is ideal to have this form completed during the visit and given to your clinic pharmacist when sending the Rx to the pharmacy.

	[https://www.anthc.org/what-we-do/clinical-and-research-services/hep/hep-c-treatment-information/\| ANTHC Hepatitis C Treatment]		[https://www.anthc.org/what-we-do/clinical-and-research-services/hep/hep-c-treatment-information/\| ANTHC Hepatitis C Treatment Information]

	===Resources/References===		===Resources/References===

LiamG at 13:54, 2 August 2023

2023-08-02T13:54:40Z

← Older revision		Revision as of 13:54, 2 August 2023
Line 3:		Line 3:
	If a patient is to be started on glecaprevir/pibrentasvir, the [http://dhss.alaska.gov/dhcs/Documents/pharmacy/forms/AK_Hep_C_DAA_Fax_Form_20171001.pdf medication prior authorization form] needs to be filled out by BOTH patient and provider prior to the medication being dispensed. It is ideal to have this form completed during the visit and given to your clinic pharmacist when sending the Rx to the pharmacy.		If a patient is to be started on glecaprevir/pibrentasvir, the [http://dhss.alaska.gov/dhcs/Documents/pharmacy/forms/AK_Hep_C_DAA_Fax_Form_20171001.pdf medication prior authorization form] needs to be filled out by BOTH patient and provider prior to the medication being dispensed. It is ideal to have this form completed during the visit and given to your clinic pharmacist when sending the Rx to the pharmacy.

	[https://www.anthc.org/what-we-do/clinical-and-research-services/hep/hep-c-treatment-information/ \| ANTHC Hepatitis C Treatment]		[https://www.anthc.org/what-we-do/clinical-and-research-services/hep/hep-c-treatment-information/\| ANTHC Hepatitis C Treatment]

	===Resources/References===		===Resources/References===

LiamG at 13:54, 2 August 2023

2023-08-02T13:54:24Z

← Older revision		Revision as of 13:54, 2 August 2023
Line 3:		Line 3:
	If a patient is to be started on glecaprevir/pibrentasvir, the [http://dhss.alaska.gov/dhcs/Documents/pharmacy/forms/AK_Hep_C_DAA_Fax_Form_20171001.pdf medication prior authorization form] needs to be filled out by BOTH patient and provider prior to the medication being dispensed. It is ideal to have this form completed during the visit and given to your clinic pharmacist when sending the Rx to the pharmacy.		If a patient is to be started on glecaprevir/pibrentasvir, the [http://dhss.alaska.gov/dhcs/Documents/pharmacy/forms/AK_Hep_C_DAA_Fax_Form_20171001.pdf medication prior authorization form] needs to be filled out by BOTH patient and provider prior to the medication being dispensed. It is ideal to have this form completed during the visit and given to your clinic pharmacist when sending the Rx to the pharmacy.

	[https://www.anthc.org/what-we-do/clinical-and-research-services/hep/hep-c-treatment-information/\|ANTHC Hepatitis C Treatment]		[https://www.anthc.org/what-we-do/clinical-and-research-services/hep/hep-c-treatment-information/ \| ANTHC Hepatitis C Treatment]

	===Resources/References===		===Resources/References===

LiamG at 13:53, 2 August 2023

2023-08-02T13:53:57Z

← Older revision		Revision as of 13:53, 2 August 2023
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	Anyone with untreated Hepatitis C can be given ~~Mayret~~ for 8 weeks. Please call the ANMC Hepatology team with any questions and see the Resources below for a link to the Prior Authorization Form.		Anyone with untreated Hepatitis C can be given glecaprevir/pibrentasvir (Mavyret™) for 8 weeks. Please call the ANMC Hepatology team with any questions and see the Resources below for a link to the Prior Authorization Form.

	If a patient is to be started on ~~Mavyret~~, the [http://dhss.alaska.gov/dhcs/Documents/pharmacy/forms/AK_Hep_C_DAA_Fax_Form_20171001.pdf medication prior authorization form] needs to be filled out by BOTH patient and provider prior to the medication being dispensed. It is ideal to have this form completed during the visit and given to your clinic pharmacist when sending the Rx to the pharmacy.		If a patient is to be started on glecaprevir/pibrentasvir, the [http://dhss.alaska.gov/dhcs/Documents/pharmacy/forms/AK_Hep_C_DAA_Fax_Form_20171001.pdf medication prior authorization form] needs to be filled out by BOTH patient and provider prior to the medication being dispensed. It is ideal to have this form completed during the visit and given to your clinic pharmacist when sending the Rx to the pharmacy.

	[https://www.anthc.org/what-we-do/clinical-and-research-services/hep/hep-c-treatment-information/]		[https://www.anthc.org/what-we-do/clinical-and-research-services/hep/hep-c-treatment-information/\|ANTHC Hepatitis C Treatment]

	===Resources/References===		===Resources/References===

LiamG at 13:49, 2 August 2023

2023-08-02T13:49:38Z

← Older revision		Revision as of 13:49, 2 August 2023
Line 2:		Line 2:

	If a patient is to be started on Mavyret, the [http://dhss.alaska.gov/dhcs/Documents/pharmacy/forms/AK_Hep_C_DAA_Fax_Form_20171001.pdf medication prior authorization form] needs to be filled out by BOTH patient and provider prior to the medication being dispensed. It is ideal to have this form completed during the visit and given to your clinic pharmacist when sending the Rx to the pharmacy.		If a patient is to be started on Mavyret, the [http://dhss.alaska.gov/dhcs/Documents/pharmacy/forms/AK_Hep_C_DAA_Fax_Form_20171001.pdf medication prior authorization form] needs to be filled out by BOTH patient and provider prior to the medication being dispensed. It is ideal to have this form completed during the visit and given to your clinic pharmacist when sending the Rx to the pharmacy.

			[https://www.anthc.org/what-we-do/clinical-and-research-services/hep/hep-c-treatment-information/]

	===Resources/References===		===Resources/References===