PA Requests for Select Hepatitis C Medications Online Only on May 1

Prior approval for these Hepatitis C medications can be requested via the secure provider portal using the HepC Drug Type.The new HepC Drug Type screens have questions that mirror the paper forms. When submitting a PA request for Hepatitis C medications via the portal, the required supporting documentation outlined below must be uploaded via the attachment feature.Refer to the User Guides page of the provider portal for “How to Submit Prior Approval Attachments in NCTracks.”

Note: Requests for PEG-interferon and Ribavirin products are still found under the “non-preferred” drug type.

Note: Daklinza will continue to be accepted using the form currently available on the NCTracks website. When requesting Daklinza for genotype 3 HCV, be sure to also send a request for Sovaldi using the secure provider portal.

Prior Approval for Hepatitis C medications requires that the provider submit medical records and documentation of the diagnosis of chronic Hepatitis C with genotype and subtype if applicable. Specific drug requirements and needed documentation are outlined on the Prior Approval Drugs and Criteria webpage of the NCTracks website, under the Hepatitis C medications link.

Below is a summary of the supporting documentation that must be uploaded and attached to the PA request, when it is submitted via the secure provider portal:

ATTACHMENT 1	Medical record documentation for diagnosis of chronic hepatitis C with genotype and subtype (if applicable)
ATTACHMENT 2	Medical record documentation for Fibrosis stage
ATTACHMENT 3	Actual lab results (not progress notes) showing HCV RNA levels. For initial requests, lab results must be collected in the previous 6 months. For continuation, lab results must be collected 4 or more weeks after the first prescription fill date.
ATTACHMENT 4	Additional information such as patient’s health status and history, treatment plan, contra-indications etc. (if applicable)  The patient “readiness to treat” form is required for initial PAs, regardless of submission method, and must be signed and dated by the beneficiary and attached as well.

A new Job Aid will be available soon in SkillPort to assist providers with submitting PA requests for Hepatitis C medications using the new HepC Drug Type screens. To access the Job Aid once it is posted, logon to the secure NCTracks Provider Portal and click Provider Training to access SkillPort. Open the folder labeled User Guides. The course will be found in the sub-folder labeled Reference Documents. Refer to the Provider Training page of the public Provider Portal for specific instructions on how to use SkillPort. The Provider Training page also includes a quick reference regarding Java, which is required for the use of SkillPort.