Viekira Pak now preferred under NYS Medicaid Fee For Service (FFS)

Update 3/27/15: NYS Commissioner of Health approves changes for Viekira Pak Medicaid FFS prior authorization

Medicaid Pharmacy Prior Authorization Programs Update
On February 26, 2015, the New York State Medicaid Drug Utilization Review (DUR) Board recommended changes to the Medicaid pharmacy prior authorization programs. The Commissioner of Health has reviewed the recommendations of the Board and has approved changes to the fee-for-service pharmacy prior authorization programs:

Effective April 9, 2015, prior authorization (PA) requirements will change for some drugs in the Hepatitis C – Direct Acting Antivirals class:

  • Preferred Agents: ribavirin, Viekira*
  • Non-Preferred Agents: Copegus, Harvoni, Moderiba, Olysio, Rebetol, Ribapak, Ribasphere, Sovaldi, Victrelis

* Viekira to be excluded from the Hepatitis C Virus clinical criteria** addressing disease prognosis and severity
** [NYS Medicaid Hep C Clinical Criteria Updated October 2014]

 


On Feb 26th, 2015, the NYS Drug Utilization Review Board (DURB) voted unanimously to move Viekira Pak to preferred status for NYS Medicaid Fee-for-service members, and to remove restrictions based on disease prognosis and severity from the current clinical criteria for Viekira Pak. This change in status and clinical criteria applies only to NYS Medicaid FFS members and not to NYS Medicaid Managed Care Organization (MCO) members, who comprise the majority (more than 70%) of Medicaid beneficiaries in NYS.

The following is an excerpt from an email sent by Colleen Flanigan, Director, Viral Hepatitis Section of the NYS Department of Health.


 

At yesterday’s NYSDOH Drug Utilization Review Board meeting, the board voted to approve Viekira Pak as its preferred drug for persons chronically infected with HCV and enrolled in FFS Medicaid. Viekira Pak will be available for all chronically infected persons regardless of disease severity. This drug is also FDA approved for HIV coinfection and has transplant indications.

Note that this only applies to patients enrolled in FFS Medicaid and does not apply to persons enrolled in Medicaid Managed Care Plans. Providers should consult the formularies of each of the managed care plans to determine which drug(s) is/are approved, drug restrictions and for additional prior authorization information.

NYS Medicaid Managed Care drug look-up web page now has a feature that allows you to quickly view the formularies of the various managed care plans, to see if a specific HCV medication is covered.

Click on the link – http://pbic.nysdoh.suny.edu/search/

Click on the tab “Therapeutic Classes, Other”

Check “Hepatitis C Agents- Direct Acting Antivirals”

 

Below is the link to the audio version of the DURB meeting.

http://www.health.ny.gov/events/webcasts/2015/2015-02-26_durb.htm

We know that this is a moving target with more drug soon to be approved that may impact cost. The DURB will continue to monitor and provide additional updates at the next meeting.

Colleen Flanigan
Director, Viral Hepatitis Section
New York State Department of Health
AIDS Institute
Empire State Plaza, Corning Tower – 429
Albany, NY 12237

The February 26, 2015, Drug Utilization Review Board meeting summary is now posted on the DoH web-site. To view, please see the following link:
http://www.health.ny.gov/health_care/medicaid/program/dur/meetings/2015/index.htm

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