ASES Updates Coverage for Hepatitis C Treatment in VITAL Patients • WIPR


In the spirit of continuing to contribute to hepatitis C screening and effective health care, on the occasion of Official Testing Day, Administration of Health Insurance Administration (ASES) Director Edna Y. Marín Ramos, announced this latest coverage for the treatment of the conditions listed above.

In regulatory letter 20-1009-Amendment A to insurers, mental health services companies, pharmacy benefit managers, pharmacies, primary care groups and providers participating in the Vital Plan, the official said that now through the update, the focus is on improving the Linked to patient care, certification requirements are removed so that primary care physicians can treat hepatitis C without additional restrictions.

Patients of any complexity should coordinate treatment with specialists, according to established guidelines, he added. Physicians from each insurance company’s network or outside may also prescribe Mavyret or other hepatitis C medications as long as they have been evaluated (pre-authorized) by the patient’s insurance company. Treatments other than Mavyret must be evaluated by insurance companies through an exceptions process so that patients will always be able to receive treatment based on their medical condition.

Among other changes, the Mavyret clinical protocol has been modified to facilitate access to treatment. These include requirements for monitoring treatment adherence and promoting adherence. Additionally, the statement was removed: “When a patient confirms that a medication has been lost, stolen or misplaced, no additional supplies will be authorized.”

Likewise, the request to execute fiber scan Although it is still one of the tests available under special coverage to determine liver damage before starting treatment.

Director of ASES stated, “Any diagnosed patient has the right to have his/her course of treatment registered by his doctor or specialist under Hepatitis C Special Coverage. Companies get the information they need, and they have no more than 72 hours to register a patient.”

“These changes make treatment of choice readily available to people currently diagnosed with hepatitis C. Together we can eliminate hepatitis C in Puerto Rico. The government of Puerto Rico, under Law 67 of 2023, will eradicate hepatitis A, B and C The different ways hepatitis is identified as a public policy. It is a mandate and we will abide by it,” said Marín Ramos, referring to the fact that after the age of 18, guidelines recommend screening at least once in a lifetime.

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