Hepatitis C Medications

Prior Authorization is required for hepatitis C treatment. Prior Authorization Submission Requirements are below.

The following MUST be submitted to MedStar Family Choice-DC for a request for hepatitis C treatment to be processed:

1. A completed Hepatitis C Prior Authorization Form.

2. Medical records including:
1. Most recent office visit note(s) which includes:
1. Detail on all previous hepatitis C treatments; if none, the note must say “treatment naïve.”
2. Child-Pugh score (if cirrhotic).
3. Social history with detail provided on use of ETOH and/or illicit substances.
3. Laboratory studies including:
1. a recent (less than 6 months old) baseline viral load.
2. genotype.
3. (If applicable) HIV viral load and/or hepatitis B viral load.
4. No fibrosis score required. 

Submit the completed form and required documentation via fax to 202-243-6258.

Physicians may call MedStar Family Choice-DC at 855-798-4244 for questions or concerns, or fax requests to 202-243-6258.