Hepatitis C Virus (HCV) Pharmacy Benefit Carve Out
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.