Hepatitis C
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
