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Hepatitis C Resources

The Michigan Department of Health and Human Services announced a public health campaign, We Treat Hep C, aimed at eliminating hepatitis C virus (HCV) in Michigan. The initiative involves:

  • Increasing the number of people who are tested for HCV
  • Increasing the number of providers who treat HCV
  • Expanding access to HCV curative treatments

For more information about this initiative, view the care coordination plan for the “We Treat HEP C” initiative from the MDHHS. Below are some frequently asked questions for providers.

Member outreach

Testing

Treatment

Resources

How do you educate members on hepatitis C?

We sent a letter to all HAP Empowered Medicaid members, age 18 and older. The letter had general information about HCV and the importance of testing. We’ll also send a letter to new members that enroll with HAP Empowered. Letters were also sent to all HAP Empowered MI Health Link members, and information on HCV is now included in the New Member Packets.

How do you help members who need transportation for testing or treatment?

Members can call our Customer Service team to schedule a ride. They can be reached at (888) 654-2200 (TTY 711). Information about the transportation benefit can be found:

  • On the HAP Empowered website
  • In the member handbook 

What testing guidelines should be followed?

The CDC recommends all adults ages 18 and older should be tested for HCV at least once in a lifetime. Pregnant women should be tested during each pregnancy. The table below outlines the CDC recommendations for HCV screening. Providers are encouraged to make this testing part of routine primary care.

For

CDC recommendations 
Universal hepatitis C screening 
  • Hepatitis C screening at least once in a lifetime for all adults aged 18 years
    and older, except in settings where the prevalence of HCV infection (HCV
    RNA‑positivity) is less than 0.1%*
  • Hepatitis C screening for all pregnant women during each pregnancy,
    except in settings where the prevalence of HCV infection (HCV RNA-positivity)
    is <0.1%* 
One-time hepatitis C testing regardless of age or setting prevalence among people with recognized conditions or exposures 
  • People with HIV
  • People who ever injected drugs and shared needles, syringes, or other drug
    preparation equipment, including those who injected once or a few times
    many years ago
  • People with selected medical conditions, including persons who ever received
    maintenance hemodialysis and persons with persistently abnormal ALT levels
  • Prior recipients of transfusions or organ transplants, including people who:
    • Received clotting factor concentrates produced before 1987
    • Received a transfusion of blood or blood components before July 1992
    • Received an organ transplant before July 1992
    • Were notified that they received blood from a donor who later tested
      positive for HCV infection
    • Health care, emergency medical, and public safety personnel after needle
      sticks, sharps, or mucosal exposures to HCV‑positive blood
    • Children born to mothers with HCV infection
Routine periodic testing for people with ongoing risk factors, while risk factors persist 
  • People who currently inject drugs and share needles, syringes, or other drug
    preparation equipment
  • People with selected medical conditions, including people who ever received
    maintenance hemodialysis 
Any person who requests hepatitis C testing  These persons should receive it, regardless of disclosure of risk, because many persons might be reluctant to disclose stigmatizing risks 
*Determining prevalence: In the absence of existing data for hepatitis C prevalence, health care providers should initiate universal hepatitis C screening until they establish that the prevalence of HCV RNA positivity in their population is less than 0.1%, at which point universal screening is no longer explicitly recommended but may occur at the provider’s discretion.
Source: https://www.cdc.gov/hepatitis/hcv/guidelinesc.htm 

What does HCV screening involve?

Screening for HCV involves measuring antibody to HCV in a person’s serum. A reactive or positive test (detection of the antibody) is not a diagnosis of the disease. It only means a
person was previously exposed to the virus. Note:

  • If the antibody test is reactive, then:
    • A nucleic acid test (known as a polymerase chain reaction [PCR] test) for HCV
      ribonucleic acid (RNA) is needed to determine if the person currently has active
      HCV infection. (Note: Often, the antibody test and the RNA test can be performed
      on a single blood draw, with a positive antibody test automatically reflexing to the
      HCV RNA test).
  • If the HCV RNA test is positive, then:
    • HCV treatment can be prescribed.

Be sure to follow the CDC HCV testing algorithms. They can be found here.

How does HAP Empowered help members who test positive?

Our case managers assess the current treatment status. They will help resolve any issues or barriers to receiving treatment.

Does HAP Empowered have any initiatives to routinize testing?

Yes. We have the following initiatives:

  • Our Care Management team has developed an outreach plan for:
    • Members needing HCV screening
    • Members diagnosed with HCV
  • We ensure the member is connected with their primary care physician. We continue to provide ongoing support and follow up.
  • Part of our maternity care program ensures the member gets all recommended screenings. HCV screening is included.
  • Part of the health screening of new members includes HCV screening questions. Our care management team will follow up with members who have not completed screening.
  • We added information on hepatitis C screening and treatment to:
    • The member handbook
    • The member newsletter
    • Our website
  • Our Care Management team partners with the following groups to outreach to members:
    • Community-based organizations
    • Homeless shelters
    • Local health departments
    • Federally Qualified Health Centers 

Does HAP Empowered have any initiatives to increase HCV testing and treatment among persons with a history of substance use?

All members, including those with a history of substance abuse, are encouraged to get HCV testing and treatment. Our Care Management team collaborates with Prepaid Inpatient Health Plans (PIHPs) on shared members during monthly meetings. HCV testing and treatment for these members is addressed when applicable.

What is the recommended treatment for HCV?

Recently, direct-acting antivirals (DAA) were developed to treat HCV. DAAs are oral medications that can cure the disease when taken daily for several weeks. They have few side effects or contraindications.

The MDHHS has a three-year agreement with the manufacturer AbbVie to expand access to the DAA MAVYRET® (glecaprevir/pibrentasvir) for Medicaid and Healthy Michigan Plan beneficiaries. MAVYRET is an oral prescription medication. It’s used to treat adults and children ages 12 and older with HCV.

To minimize medication barriers, the prescription should be written for the full course of therapy in one fill. In most cases, this is an eight week supply. If you prescribe the full course of therapy in one fill, the pharmacy can fill it in one prescription.

Providers are encouraged to enroll their patients receiving MAVYRET into the MAVYRET Nurse Ambassador program. Information can be found here. 

What are authorization requirements for MAVYRET and other DAAs?

For all Michigan Medicaid plans and for HAP Empowered MI Health Link MMP, the preferred drug is Mavyret and it is available without a prior authorization or quantity limit.

Any provider who can prescribe, can prescribe MAVYRET and other DAAs.

Medicaid

Preferred DAA

MAVYRET (glecaprevir and pibrentasvir)

Non-Preferred DAAs 
(prior authorization required)
  • Epclusa
  • Harvoni
  • ledipasvir/sofosbuvir(generic for Harvoni)
  • sofosbuvir/velpatasvir (generic for Epclusa)
  • Sovaldi
  • Viekira Pak
  • Vosevi
  • Zepatier
 

HAP Empowered MI Health Link

Preferred DAA

MAVYRET (glecaprevir and pibrentasvir)

Non-Preferred DAAs 
(prior authorization required)

 Zepatier

How does HAP Empowered ensure members with an HCV diagnosis are linked to a provider familiar with HCV treatment?

Our Care Management teams help coordinate care with the member’s PCP. If specialist care is needed, they help find contracted providers close to the member’s home. They can also help with scheduling appointments.

How does HAP Empowered follow up with members receiving treatment to offer support on medication adherence?

Our Pharmacy team gets a weekly report of all pharmacy claims (YTD) for hepatitis C antivirals. Note:

MAVYRET (glecaprevir and pibrentasvir)

Preferred DAA
A 28-day supply  The Pharmacy team contacts the pharmacy to ensure there is a refill allowed on the prescription. Then they contact the member to encourage them to get the refill in a timely manner. 
A 56 or 84-day supply  The member has the full course of therapy. Members being followed by our Care Management team will receive a medication reminder. The Pharmacy team will contact the member as needed. 

Similar activities and reach-out occur if a DAA other than Mavyret is prescribed.

HAP Empowered also communicates with pharmacy providers related to medication treatment:

  • Electronic bulletins to the pharmacy network
  • Reach-out to individual pharmacies when needed to facilitate medication adherence

Does HAP Empowered track members with an HCV diagnosis and no record of treatment?

Yes. A report is shared with Care Management teams monthly to facilitate review and follow up.

Resources

MDHHS has partnered with several organizations for resources to help providers treat HCV patients. Please see the table below.

For 

Contact 
Consulting line for all health care professionals with questions about HCV treatment   Henry Ford Health System
(313) 575-0332
8 a.m. to 5 p.m. daily 
  • On-demand webinars
  • Live training events
  • Office hours
  • Other resources for health care
    professionals on treating HCV 
 Midwest AIDS Training and Education Center (MATEC) at Wayne State University School of Medicine Division of Infectious Diseases - matecmichigan.com
Education and case consultation on HCV  Michigan Opioid Collaborative 
Additional resources   Michigan.gov/WeTreatHepC 
Notification of new training opportunities and events  Send a request to be added to the listserv:
Email MDHHS-Hepatitis@michigan.gov