Hepatitis C Treatment | Alaska Native Tribal Health Consortium

Hepatitis C Treatment

Forms, decision trees and prescribing information

We want to keep you informed of recent drugs, screenings, treatments, and other news pertaining to Hepatitis and other liver diseases. As news becomes available we will post content here. Check back often to stay informed!



  

Simplified Treatment — 3 Easy Steps

 

Who Is Eligible?

 

Who Is NOT Eligible?

Adults with hepatitis C (any genotype) who do NOT have cirrhosis or have compensated cirrhosis (CTP score < 6) and persons who have not previously received HCV treatment

Persons with cirrhosis should be referred to Liver Clinic for cirrhosis evaluation and follow up. Those with compensated cirrhosis, i.e. CTP < 6 [see Step 1 below for CTP calculation] can still receive Simplified Treatment; consult Liver Clinic for treatment recommendations.
Patients who have any of the following:
– Prior HCV treatment
– Current or prior episode of decompensated cirrhosis, defined as Child-Turcotte-Pugh (CTP) score > 6 or presence of ascites, hepatic encephalopathy, total bilirubin > 2.0mg/dL, albumin < 3.5g/dL, or INR > 1.7
– HIV positive
– HBsAg positive
– Current pregnancy
– End-stage renal disease (i.e. eGFR <30mL/min/m2)
– Known or suspected hepatocellular carcinoma
– Prior liver transplantation

Step 1: Determine FIB-4 Score

FIB-4 Calculator
You will need age, ALT and AST, and platelet count

 

FIB-4 < 1.45

 

FIB-4 (1.45-3.25)

 

FIB-4 > 3.25

No Cirrhosis Indeterminate Fibrosis
Fibrosis Interpretation
Cirrhosis
Calculate CTP Score
 

Step 2: Obtain Pre-Treatment Labs

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 TestImmediately prior to treatment start and counsel about pregnancy risk with HCV medication
HCV RNAAcceptable within past 6 months
Hepatic function panel and eGFRAcceptable within past 6 months
AFPAcceptable within past 6 months
CBC (without diff)Acceptable within 3 months if cirrhosis, 6 months if no cirrhosis
PT/INR (only needed in cirrhosis)Acceptable within 3 months
HCV genotypeNot needed if treating with pangenotypic treatment; recommended if patient has cirrhosis, past treatment failure, or concern for reinfection; anytime prior
HIV antigen/antibodyAnytime prior
Hepatitis B surface antigenAnytime prior
 

Step 3: Write Prescription

 
 

State of Alaska Medicaid Prior Authorization
Hep Drug Interactions
Prescription Assistance Programs

 

Simplified Tx Prescribing Information

Glecaprevir/Pibrentasvir (Mavyret™)
Sofosbuvir/Velpatasvir (Epclusa®)

HCV Tx Documents

Simplified Treatment Checklist
Patient Readiness Attestation
Hepatitis C Information
Alcohol Use Disorders Identification Test (Audit-C)
Patient Health Questionnaire (PHQ-9)
Health Summary
Pre-Treatment Letter
Letter: End of Treatment
Letter: SVR 12
Letter: SVR 12 Cured
Medication Information Packet
Treatment Medications and Dosing
Patient Assistance Programs

 
  

Treatment Experienced Patients

Consult Liver Disease Specialist

 
  

Prescribing Information for Other Medications

Elbasvir/Grazoprevir (Zepatier™)
Ledipasvir/Sofosbuvir (Harvoni®)
Sofosbuvir/Velpatasvir/Voxelaprevir (Vosevi®)

 

AASLD Recommendations for Testing, Managing, and Treating Hep C
FDA Approved Drug Search

 

Adult Hepatitis Clinic
Internal Medicine Clinic
Healthy Communities Building
3rd Floor
Phone: (907) 729-1500

Pediatric Clinic
Anchorage Native Primary Care Center
First Floor
Phone: (907) 729-1000

Liver Disease & Hepatitis Program
Phone: (907) 729-1560
1-800-655-4837

Internal