If you were denied hepatitis C treatment in 2015, you may want to resubmit in 2016. That’s because some insurance companies and state Medicaid programs are loosening their hepatitis C treatment requirements. The most recent to open up is United Healthcare. They removed the restriction requiring evidence of cirrhosis as a condition for hepatitis C treatment. United Healthcare still requires documentation of fibrosis stage (APRI score, FibroSure score, Fibroscan score, biopsy, etc.). Assuming my sources are correct, this means that United Healthcare, Anthem Blue Cross, Cigna, Aetna, Humana, CVS, and Optum now have no fibrosis restrictions, allowing F0-4.
However, United Healthcare still maintains a restrictive substance abuse policy. People with no known history of illicit drug or alcohol abuse will be treated, presumably without proof.
Those with a known prior history of drug abuse or alcohol abuse who have abstained from substances for the past 6 months must submit a negative urine drug screen collected within 30 days prior to onset of treatment. A positive urine drug test is not an automatic disqualification if there is a legitimate prescription for medication that would result in a positive test (i.e., methylphenidate causing positive findings for amphetamines, hydrocodone causing positive findings for opiates, etc.). A urine drug screen testing positive for cannabinoids will not disqualify authorization if there is a prescription for Marinol, or if the physician attests to prescribing medical marijuana in states where legal, or in states where the recreational use of marijuana has been legalized.
Like many state Medicaid programs, United Healthcare will only approve hepatitis C treatment that is prescribed by a hepatologist, gastroenterologist, infectious disease specialist, or HIV specialist certified through the Academy of HIV Medicine.
If you are pursuing hepatitis C treatment, I highly recommend working with a Patient Assistance program, such as the Hepatitis C Careline. Click here for a list of Patient Assistance programs.