Alabama Medicaid Pharmacy Hepatitis C Antiviral Agents Prior Authorization Request Form

The Alabama Medicaid Agency published the form on January 12, 2022. It states that preferred Hepatitis C Antiviral Agents will be considered “preferred with clinical criteria". These agents will require this prior authorization request be submitted. Clinical criteria must be met in order to be approved. Non-preferred products will continue to require prior authorization. For a non-preferred product to be approved, contraindication to preferred agents must exist or the non-preferred agent must be prescribed for a genotype for which all preferred agents are not approved by the U.S. Food and Drug Administration (FDA . . .