Hepatitis C: Difference between revisions

Latest revision as of 19:47, 16 September 2025

Adults with hepatitis C (any genotype) who do NOT have cirrhosis or have compensated cirrhosis (Child-Turcotte-Pugh (CTP) score < 6) and persons who have not previously received HCV treatment are eligible for simplified treatment pathway.

Patients who have any of the following are not eligible and need consultation with a liver disease specialist:

Prior HCV treatment
Current or prior episode of decompensated cirrhosis, defined as CTP score > 6 or presence of ascites, hepatic encephalopathy, total bilirubin > 2.0mg/dL, albumin < 3.5g/dL, or INR > 1.7
HBsAg positive
Current pregnancy
Known or suspected hepatocellular carcinoma
Prior liver transplantation

Step 1: Determine FIB-4 Score and Assess for Cirrhosis and proceed if FIB-4 < 3.25 without cirrhosis or CTP < 7 with cirrhosis.

Step 2: Pre-treatment Labs and Assessment.

Lab	How Recent?
If FIB-4 is indeterminate (1.45 – 3.25), Serum Fibrosis Test (FibroSure/Labcorp or FibroTest/Quest) or obtain FibroScan if test available (i.e. ANMC)	Complete prior to choosing HCV medication – Fibrosis Interpretation
Pregnancy Test	Immediately prior to treatment start and counsel about pregnancy risk with HCV medication
HCV RNA	Acceptable within past 6 months
CBC (without diff)	Acceptable within 3 months if cirrhosis, 6 months if no cirrhosis
Hepatic function panel	Acceptable within past 6 months
Calculate Estimated Glomerular Filtration Rate (eGFR)	Acceptable within past 6 months
AFP (only needed in cirrhosis)	Acceptable within past 6 months
PT/INR (only needed in cirrhosis)	Acceptable within 3 months
HCV genotype	Only needed if patient has cirrhosis and will be treated with sofosbuvir/velpatasvir
HIV antigen/antibody	Anytime prior
Hepatitis B surface antigen	Anytime prior
Syphilis screening	Anytime prior

Step 3: Treat.

Glecaprevir/Pibrentasvir (Mavyret™) 3 tablets daily x 8 weeks, or
Sofosbuvir/Velpatasvir (Epclusa®) 1 tablet daily x 12 weeks

As decided by P&T committee April 24, 2019, all hepatitis C medications will be treated as an "open formulary.”

Pharmacy will not routinely stock the medications, but will order in the medication when it is prescribed without a non-formulary request needing to be filled out.

Some private insurances will require prior authorization.

Resources/References

Adapted from ANTHC Liver Disease and Hepatitis Program
American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society of America (IDSA) Simplified HCV Treatment for Treatment-Naive Adults Without Cirrhosis
AASLD and IDSA Simplified HCV Treatment Algorithm for Treatment-Naive Adults With Compensated Cirrhosis

Common/Unique Medical Diagnoses

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-Anyone with untreated Hepatitis C can be given glecaprevir/pibrentasvir (Mavyret™) for 8 weeks.    Please call the ANMC Hepatology team with any questions and see the Resources below for a link to the Prior Authorization Form.
+Adults with hepatitis C (any genotype) who do NOT have cirrhosis or have compensated cirrhosis (Child-Turcotte-Pugh (CTP) score < 6) and persons who have not previously received HCV treatment are eligible for simplified treatment pathway.
-If a patient is to be started on glecaprevir/pibrentasvir, the [http://dhss.alaska.gov/dhcs/Documents/pharmacy/forms/AK_Hep_C_DAA_Fax_Form_20171001.pdf medication prior authorization form] needs to be filled out by BOTH patient and provider prior to the medication being dispensed. It is ideal to have this form completed during the visit and given to your clinic pharmacist when sending the Rx to the pharmacy.
+Patients who have any of the following are not eligible and need consultation with a liver disease specialist:
+* Prior HCV treatment
+* Current or prior episode of decompensated cirrhosis, defined as CTP score > 6 or presence of ascites, hepatic encephalopathy, total bilirubin > 2.0mg/dL, albumin < 3.5g/dL, or INR > 1.7
+* HBsAg positive
+* Current pregnancy
+* Known or suspected hepatocellular carcinoma
+* Prior liver transplantation
+Step 1: Determine FIB-4 Score and Assess for Cirrhosis and proceed if FIB-4 < 3.25 without cirrhosis or CTP < 7 with cirrhosis.
+Step 2: Pre-treatment Labs and Assessment.
+{| class="wikitable"
+!Lab
+!How Recent?
+|-
+|If FIB-4 is indeterminate (1.45 – 3.25), Serum Fibrosis Test (FibroSure/Labcorp or FibroTest/Quest) or obtain FibroScan if test available (i.e. ANMC)
+|Complete prior to choosing HCV medication – Fibrosis Interpretation
+|-
+|Pregnancy Test
+|Immediately prior to treatment start and counsel about pregnancy risk with HCV medication
+|-
+|HCV RNA
+|Acceptable within past 6 months
+|-
+|CBC (without diff)
+|Acceptable within 3 months if cirrhosis, 6 months if no cirrhosis
+|-
+|Hepatic function panel
+|Acceptable within past 6 months
+|-
+|Calculate Estimated Glomerular Filtration Rate (eGFR)
+|Acceptable within past 6 months
+|-
+|AFP (only needed in cirrhosis)
+|Acceptable within past 6 months
+|-
+|PT/INR (only needed in cirrhosis)
+|Acceptable within 3 months
+|-
+|HCV genotype
+|Only needed if patient has cirrhosis and will be treated with sofosbuvir/velpatasvir
+|-
+|HIV antigen/antibody
+|Anytime prior
+|-
+|Hepatitis B surface antigen
+|Anytime prior
+|-
+|Syphilis screening
+|Anytime prior
+|}
+Step 3: Treat.
+* Glecaprevir/Pibrentasvir (Mavyret™) 3 tablets daily x 8 weeks, or
+* Sofosbuvir/Velpatasvir (Epclusa®) 1 tablet daily x 12 weeks
+As decided by P&T committee April 24, 2019, all hepatitis C medications will be treated as an "open formulary.”
+Pharmacy will not routinely stock the medications, but will order in the medication when it is prescribed without a non-formulary request needing to be filled out.
+Some private insurances will require prior authorization.
 ===Resources/References===
-*[https://www.anthc.org/what-we-do/clinical-and-research-services/hep/hep-c-treatment-information/| ANTHC Hepatitis C Treatment Information]
+*Adapted from [https://anthc.org/community-health/wellness/#hep ANTHC Liver Disease and Hepatitis Program]
-*[http://dhss.alaska.gov/dhcs/Documents/pharmacy/forms/AK_Hep_C_DAA_Fax_Form_20171001.pdf Alaska Medicaid Prior Authorization Form Hepatitis C Direct Acting Antivirals – New Starts]
+*American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society of America (IDSA) [https://www.hcvguidelines.org/treatment-naive/simplified-treatment Simplified HCV Treatment for Treatment-Naive Adults Without Cirrhosis]
-* [[media:Liver Disease Updates 10.6.17.pdf|Liver Disease Updates 2017]] (PowerPoint Presentation)
+*AASLD and IDSA [https://www.hcvguidelines.org/treatment-naive/simplified-treatment-compensated-cirrhosis Simplified HCV Treatment Algorithm for Treatment-Naive Adults With Compensated Cirrhosis]
-* [[media:Hep C Update 2015.pdf|Hepatitis C Update 2015]] (PowerPoint Presentation)
 [[Practicing Medicine in Bush Alaska—Some ABCs|Common/Unique Medical Diagnoses]]