CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A
Entecavir (Baraclude) coverage for chronic hepatitis B and prophylaxis
Defines medical necessity criteria, authorization durations, and continuation requirements for entecavir (Baraclude) for treatment of chronic hepatitis B infection, HBV/HIV coinfection, and HBV reactivation/reinfection prophylaxis for members of Neighborhood Health Plan of Rhode Island.
Policy Summary
PayerNeighborhood Health Plan of Rhode Island
PolicyEntecavir (Baraclude) coverage for chronic hepatitis B and prophylaxis
Policy CodePolicy N/A
Change TypeNo material change
Effective DateN/A
Next Review DateN/A
Key ActionObtain prior authorization and provide documentation of active viral replication (e.g., detectable HBV DNA) and clinical response for renewals.
SourceLink
POLICY UPDATE CHANGES
No material clinical or coverage changes in this revision.
6 monthsinitial authorization duration for chronic HBV treatment
12 monthsinitial authorization for HBV reactivation prophylaxis
12 monthscontinuation authorization if positive response
>=2 yrsminimum patient age
Other indications