New Prior Approval (PA) Forms for Hepatitis C medications

New forms for requesting prior approval for the Hepatitis C medications have been posted to the NC Tracks website. These forms can be found on the Drug Request Forms webpage under the heading "Temporary Hepatitis C Forms." Please also read the Hepatitis C medications policy on the PA Drugs and Criteria webpage. (See links below)

These are temporary forms. Please use these forms when requesting prior approval for this drug class. Also, please note that effective March 21, 2015, Viekira Pak® is considered a preferred medication in this class, however there are clinical criteria that must be satisfied for coverage even though it is a preferred product.