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Hepatitis C Virus (HCV) Pharmacy Benefit Carve Out

Date: 08/03/16

Effective with dates of service on or after September 1, 2016, the Indiana Office of Medicaid Policy and Planning (OMPP) will carve out coverage for medications used to treat Hepatitis C Virus (HCV) from the Managed Care Organization (MCO) benefit.

Pharmacy claims for these medications for Medicaid members enrolled in a Medicaid MCO will be covered through the Fee-For-Service (FFS) pharmacy program. All FFS coverage rules, prior authorization requirements and preferred drug classifications will apply. Questions regarding the HCV carve out should be directed to OptumRx by calling 1-855-577-6317.