A bill for an act relating to direct acting antiviral medications, including prior authorization requirements, and the Iowa medical assistance drug utilization review commission.

2025-2026 Regular Session Introduced by Zach Wahls

No prior authorization is required for hepatitis C DAAs on Iowa's Medicaid preferred drug list, and Vosevi will be reviewed for inclusion as a preferred DAA by mid-2026.

Subcommittee: Klimesh, Costello, and Wahls.

#drugs #healthandhumanservicesdepartment #hepatitis #medicalassistance #medicalassistancedrugutilizationreviewcommission #prescriptiondrugs #publicassistance

Overview

SF 433 addresses access to direct-acting antiviral medications (DAAs) for hepatitis C within Iowa’s Medicaid program and outlines a review process for adding a DAA to the preferred drug formulary. The bill seeks to reduce administrative barriers by prohibiting prior authorization for DAAs on the Medicaid preferred list and directs the Iowa Medical Assistance Drug Utilization Review Commission to evaluate Vosevi for inclusion as a preferred DAA.

Prime sponsor: Wahls

Status: Subcommittee (Klimesh, Costello, Wahls) as of March 3, 2025

Related subject areas: Drugs, public assistance, health and human services, hepatitis C, Medicaid formulary

Key Provisions

Section 1 — Direct Acting Antiviral Medications and Prior Authorization

The Department of Health and Human Services (IDHHS) shall not require prior authorization for any direct-acting antiviral medications used to treat hepatitis C that are on the Medicaid preferred drug list.

The provision overrides the department’s general prior authorization requirements for these medications when they appear on the preferred list (reference to 249A.20A(4)).

Section 2 — Iowa Medical Assistance Drug Utilization Review Commission (Vosevi Review)

The Iowa Medical Assistance Drug Utilization Review Commission must review the prescription drug Vosevi for placement on the Medicaid preferred drug formulary.

This review must occur by July 1, 2026.

The review is for Vosevi to be designated as a preferred direct-acting antiviral for hepatitis C under the formulary established pursuant to 42 U.S.C. § 1396r-8.

Affected Parties and Impacts

Medicaid Beneficiaries with Hepatitis C: Potentially faster and less burdensome access to DAAs due to eliminated prior authorization for drugs on the preferred list.

Iowa Department of Health and Human Services (IDHHS): Responsible for implementing the no-prior-authorization policy for preferred-listed DAAs and for administrative coordination related to formulary status.

Iowa Medical Assistance Drug Utilization Review Commission: Charged with evaluating Vosevi for inclusion on the preferred formulary by mid-2026.

Healthcare Providers Prescribing DAAs: May experience streamlined prescribing processes for hepatitis C treatments that are on the Medicaid preferred list.

Timeline and Procedural Notes

Introduced: February 25, 2025

Subcommittee action: March 3, 2025 (Klimesh, Costello, Wahls)

Next steps: Committee considerations and potential floor action follow the subcommittee stage

Effective date: Not specified in the text provided; changes would take effect upon enactment and implementation of the Medicaid formulary changes.

Additional Context

The bill references the Medicaid preferred drug list and formulary process under 42 U.S.C. § 1396r-8, aligning state practice with federal Medicaid rules.

If enacted, Vosevi could be considered for placement as a preferred DAA, potentially affecting formulary coverage and cost dynamics within Iowa’s Medicaid program.

Bill