Quantity Limit Change for Direct Antivirals Scheduled for May 25, 2023

Date: May 4, 2023

Attention: All Providers

Effective Date: May 25, 2023

Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective May 25, 2023, the Health and Human Services Commission (HHSC) is implementing new policies to improve access and adherence to direct antivirals. Providers will now be able to write prescriptions for the entire course of therapy for the direct antivirals, eliminating the need for additional refills.

How this impacts providers: Starting May 25, 2023, due to a HHSC directive, providers now have the option to write prescriptions for direct antivirals for the entire treatment cycle, which means patients will no longer need to request for additional refills throughout their treatment course. This will ensure that patients have access to the full course of therapy. Alternatively, providers may choose to have the patient return for further testing if warranted.

Please Note: All Medicaid patients are eligible for direct antivirals treatment with Mavyret, the primary preferred agent regardless of the client’s METAVIR fibrosis score, and prior authorization is not required. HHSC will continue to apply preferred drug list (PDL) prior authorization criteria for non-preferred agents Epclusa and Vosevi. The table below summarizes the national drug codes (NDCs) impacted by this change:

Next steps for providers: Providers should share this communication with their staff to ensure staff is aware of the new policies and how they will affect their current patients. There will no longer be quantity limits or maximum day supply coverage on direct antivirals (Mayvret, Ecplusa and Vosevi).

Why is this important: We believe these policies will help improve patient outcomes and reduce the burden on both patients and providers. By increasing access to the full course of therapy and allowing providers to make informed decisions about the duration of treatment, we hope to improve adherence and help patients achieve better health outcomes.

If you have any questions, please email TCHP Pharmacy at: tchppharmacy@texaschildrens.org.

For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.