On October 16, 2014, the fee-for-service (FFS) pharmacy program implemented clinical criteria for Hepatitis C Virus (HCV) drug therapy, as was recommended by the Drug Utilization Review Board (DURB) at the September 18, 2014 meeting. Included in this criteria were the following practitioner experience and training requirements
- Therapy must be prescribed by a specialist (hepatologist, gastroenterologist, infectious disease specialist, transplant physician) or a health care practitioner experienced and trained in the treatment of HCV or a healthcare practitioner under the direct supervision of a listed specialist.
- Experience for non-specialists (listed above) is defined as the management AND treatment of at least 10 patients with HCV infection within the past 12 months and at least 10 HCV- related CME credits in the last 12 months.
Non-specialists or practitioners working in partnership with a specialist with experience listed above may request approval by filling out and submitting the following form:
The following is a list of NYS Medicaid practitioners that meet the above criteria:
Note Providers must be enrolled in NYS Medicaid to be eligible to order or refer services reimbursed by the Medicaid Fee-for-Service (FFS) program. For more information on this requirement the following link has been provided:CME CMS Medicaid