Listed below are medications currently available for the
treatment of chronic hepatitis C. This list was compiled
in consultation with a number of HCV medical specialists
and reflects medications recommended/prescribed for persons
who have HCV which are generally accepted by the medical
community.
*The HCV Medication List shall be periodically updated
in consultation with HCV medical specialists, at the Administrator's
discretion.
THERAPEUTIC
CLASS
|
MEDICATIONS
|
DISEASE
LEVELS
|
GENERIC NAME
|
BRAND NAME
|
3
|
4
|
5
|
6
|
Analgesics |
Acetaminophen |
Tylenol |
|
|
|
|
Acetaminophen, codeine, caffeine citrate |
Triatec |
|
|
|
|
Cannabidiol |
Sativex |
N/A |
N/A |
|
|
Dihydrocodine Hydrocodone |
Percocet |
N/A
|
N/A
|
|
|
Fentanyl |
Duragesic |
|
|
|
|
Hydromorphone Hydrochloride |
Dilaudid |
N/A
|
N/A
|
|
|
Morphine Sulphate |
Morphine |
N/A
|
N/A
|
|
|
Oxycodone HCL |
Supeudol |
N/A |
N/A |
|
|
Pentazocine Hydrochloride |
Talwin |
|
|
|
|
Propoxyphene Napsylate |
Darvon-N |
|
|
|
|
Anemia Therapy |
Folic Acid |
Folic Acid |
|
|
|
|
Anorectal Therapy |
Hydrocortisone |
Proctosedyl |
N/A |
N/A |
|
|
Anti-anxiety |
Alprazolam |
Xanax |
|
|
|
|
Nitrazepam |
Mogadon |
|
|
|
|
Antibacterial (topical) |
Chlorhexidine Acetate |
Bactigras |
|
|
|
|
Mupirocin |
Bactroban |
|
|
|
|
Polymyxine B, Sulfate |
Polysporin |
|
|
|
|
Antibiotics |
Amoxicillin
Trihydrate |
Amoxil |
|
|
|
|
Ampicillin |
Novo-Ampicillin |
|
|
|
|
Ampicillin Trihydrate |
Apo-Ampi |
|
|
|
|
Azithromycin Dihydrate |
Zithromax |
|
|
|
|
Bacampicillin Hydrochloride |
Penglobe |
|
|
|
|
Clarithromycin |
Biaxin |
|
|
|
|
Cefexime |
Suprax |
|
|
|
|
Cefuroxime Axetil |
Ceftin |
|
|
|
|
Cephalexin |
Apo-Cephalex |
|
|
|
|
Ciprofloxacin |
Cipro |
|
|
|
|
Clindamycin Hydrochloride |
Dalacin C |
|
|
|
|
Erythromycin |
Erythromycin |
|
|
|
|
Gatifloxacin |
Tequin |
|
|
|
|
Gentamicin Sulfate |
Garamycin |
|
|
|
|
Levofloxacin |
Levaquin |
|
|
|
|
Metronidazole |
Flagyl |
|
|
|
|
Moxifloxacin Hydrochloride |
Avelox |
|
|
|
|
Mupirocin |
Bactroban |
|
|
|
|
Nitrofurantoin |
MacroBID |
|
|
|
|
Norfloxacin |
Apo-Norflox |
|
|
|
|
Penicillin |
Penicillin G, V |
|
|
|
|
Pivampicillin |
Pondocillin |
|
|
|
|
Pivmecillinam Hydrochloride |
Selexid |
|
|
|
|
Spiramycine |
Rovamycine |
|
|
|
|
Tetracyclines |
Tetracyclines |
|
|
|
|
Trimethoprim Sulfamethoxazole |
Septra |
|
|
|
|
Vancomycin HCL |
Vancomycin |
|
|
|
|
Antidepressants |
Amitriptyline Hydrochloride |
Elavil |
|
|
|
|
Bupropion Hydrochloride |
Wellbutrin |
|
|
|
|
Citalopram Hydrobromide |
Celexa |
|
|
|
|
Doxepin Hydrochloride
|
Sinequan |
|
|
|
|
Fluoxetine Hydrochloride
|
Prozac |
|
|
|
|
Fluvoxamine Maleate |
Luvox |
|
|
|
|
Imipramine Hydrochloride |
Tofranil |
|
|
|
|
Mirtazapine |
Remeron |
|
|
|
|
Paroxetine Hydrochloride |
Paxil |
|
|
|
|
Sertraline Hydrochloride |
Zoloft |
|
|
|
|
Trazodone Hydrochloride |
Desyrel |
|
|
|
|
Venlafaxine Hydrochloride |
Effexor |
|
|
|
|
Antidiarrheal |
Diphenoxylate Hydrochloride |
Lomotil |
|
|
|
|
Loperamide Hydrochloride |
Imodium |
|
|
|
|
Antiemetics |
Dimenhydrinate |
Gravol |
|
|
|
|
Meclizine hydrochloride |
Bonamine |
|
|
|
|
Metoclopramide hydrochloride |
Metoclopramide |
|
|
|
|
Nabilone |
Cesamet |
|
|
|
|
Prochlorperazine Mesylate |
Stemetil |
|
|
|
|
Antiepileptic |
Gabapentin |
Neurontin |
|
|
|
|
Antifungals |
Caspofungin |
Cancidas |
|
|
|
|
Clotrimazole |
Clotrimaderm |
|
|
|
|
Fluconazole |
Diflucan |
|
|
|
|
Itraconazole |
Sporanox |
|
|
|
|
Ketoconazole |
Nizoral |
|
|
|
|
Voriconazole |
|
|
|
|
|
Antihistamines |
Brompheniramine Maleate |
Dimetapp |
|
|
|
|
Cetirizine Hydrochloride |
Reactine |
|
|
|
|
Chlorpheniramine Maleate
|
Chlor-Tripolon |
|
|
|
|
Diphenhydramine Hydrochloride
|
Benadryl |
|
|
|
|
Fexofenadine Hydrochloride
|
Allegra |
|
|
|
|
Hydroxyzine Hydrochloride |
Atarax |
|
|
|
|
Levocasbastine Hydrochloride |
Livostin Eye Drops |
|
|
|
|
Loratadine |
Claritin |
|
|
|
|
Triprolidine HCL - Pseudophedrine HCL |
Actifed |
|
|
|
|
Anti-hypercholesterolemic |
Atorvastatin Calcium |
Lipitor |
N/A
|
N/A
|
|
|
Bezafibrate |
Bezalip |
N/A |
N/A |
|
|
Cholestyramine Resin |
Questran |
N/A
|
N/A
|
|
|
Colestipol Hydrochloride |
Colestid |
N/A
|
N/A
|
|
|
Antihypertensives |
Acebutolol Hydrochloride |
Sectral |
N/A
|
N/A
|
|
|
Amlodipine Besylate |
Norvasc |
N/A
|
N/A
|
|
|
Atenolol |
Tenormin |
N/A
|
N/A
|
|
|
Bisoprolol Fumarate |
Monocor |
N/A
|
N/A
|
|
|
Carvedilol |
Coreg |
N/A
|
N/A
|
|
|
Clonidine hydrochloride |
Catapres |
N/A |
N/A |
|
|
Enalapril Maleate |
Vasotec |
N/A
|
N/A
|
|
|
Esmolol Hydrochloride |
Brevibloc |
N/A
|
N/A
|
|
|
Felodipine |
Renedil |
N/A
|
N/A
|
|
|
Fosinopril Sodium |
Monopril |
N/A
|
N/A
|
|
|
Indapamide Hemihydrate |
Gen-Indapamide |
N/A
|
N/A
|
|
|
Irbesartan |
Avapro |
N/A
|
N/A
|
|
|
Labetalol Hydrochloride |
Trandate |
N/A
|
N/A
|
|
|
Losartan Potassium |
Cozaar |
N/A
|
N/A
|
|
|
Metoprolol Tartrate |
Lopressor |
N/A
|
N/A
|
|
|
Nadolol |
Corgard |
N/A
|
N/A
|
|
|
Nifedipine |
Adalat |
N/A |
N/A |
|
|
Pindolol |
Visken |
N/A
|
N/A
|
|
|
Propranolol Hydrochloride |
Inderal |
N/A
|
N/A
|
|
|
Ramipril |
Altace |
N/A
|
N/A
|
|
|
Telmisartan |
Micardis |
N/A |
N/A |
|
|
Terazosin hydrochloride |
Terazosin |
N/A |
N/A |
|
|
Trandolapril |
Mavik |
N/A |
N/A |
|
|
Verapamil Hydrochloride |
Verapamil Hydrochloride |
N/A
|
N/A
|
|
|
Antipsychotics |
Chlorpromazine Hydrochloride |
Chlorpromazine Hydrochloride |
 |
 |
 |
|
Olanzapine |
Zyprexa |
 |
 |
 |
|
Antivirals |
Acyclovir |
Zovirax |
N/A
|
N/A
|
|
|
Famciclovir |
Famvir |
N/A
|
N/A
|
|
|
Ganciclovir Sodium |
Cytovene |
N/A
|
N/A
|
|
|
Oseltamivir Phosphate |
Tamiflu |
N/A
|
N/A
|
|
|
Valacyclovir Hydrochloride
|
Valtrex |
N/A
|
N/A
|
|
|
Valganciclovir |
Valcyte |
N/A |
N/A |
|
|
Zanamivir |
Relenza |
N/A
|
N/A
|
|
|
Anxiolytics/Sedatives |
Bromazepam |
Apo-Bromazepam |
|
|
|
|
Clonazepam |
Apo-Clonazepam |
|
|
|
|
Diazepam |
Valium |
|
|
|
|
Lorazepam |
Ativan |
|
|
|
|
Oxazepam |
Serax |
|
|
|
|
Flurazepam |
Dalmane |
|
|
|
|
Termazepam |
Restoril |
|
|
|
|
Zopiclone |
Imovane |
|
|
|
|
Bone Metabolism Regulator |
Risedronate Sodium Hemi-pentahydrate |
Actonel |
N/A |
N/A |
N/A |
|
Ca Channel Blocker |
Diltiazem Hydrochloride |
Diltiazem |
|
|
|
|
Cation-Exchange Resin |
Sodium Polystyrene Sulfonate |
Kayexalate |
N/A |
N/A |
N/A |
|
Cholestatic Liver Diseases |
Ursodiol |
Urso |
|
|
|
|
Cholinomimetic Agent |
Pilocarpine Hydrochloride |
Salagen |
|
|
|
|
Corticosteroids/Glucocorticoids |
Methylprednisolone Sodium |
Solu-Medrol |
N/A |
N/A |
N/A |
|
Prednisone |
Apo-Prednisone |
N/A |
N/A |
N/A |
|
Inhaler: |
|
|
|
|
|
Budesonide |
Pulmicort |
N/A |
N/A |
N/A |
|
Fluticasone Propionate |
Flovent |
N/A |
N/A |
N/A |
|
Salbutamol Sulfate |
Combivent |
N/A |
N/A |
N/A |
|
Nasal: |
|
|
|
|
|
Fluticanose propionate
|
Flonase |
|
|
|
|
Ophtalmic: |
|
|
|
|
|
Dexamethasone |
Tobradex |
|
|
|
|
Gentamicine |
Garamycin |
|
|
|
|
Topical: |
|
|
|
|
|
Betamethasone valerate |
Betnovate Preparations |
|
|
|
|
Desonide |
Desocort |
|
|
|
|
Diflucortolone Valerate |
Nerisone |
|
|
|
|
Hydrocortisone |
Celestoderm |
|
|
|
|
|
Cortate |
|
|
|
|
|
Kenacomb |
|
|
|
|
Triamcinolone Acetonide |
Triamcinolone |
|
|
|
|
|
Uremol |
|
|
|
|
|
Viaderm |
|
|
|
|
Diabetic Therapy |
Insulin: |
|
|
|
|
|
Intermediate |
|
|
|
|
|
Long acting |
|
|
|
|
|
Rapid |
|
|
|
|
|
Oral agents: |
|
|
|
|
|
Acarbose |
Prandase |
|
|
|
|
Chlorpropamide |
Diabinese |
|
|
|
|
Glimepiride |
Amaryl |
|
|
|
|
Glyburide |
Diabeta |
|
|
|
|
Metformin Hydrochloride |
Glucophage |
|
|
|
|
Rosiglitazone Maleate |
Avandia |
|
|
|
|
Diuretics |
Amiloride HCL |
Midamor |
N/A
|
N/A
|
|
|
Furosemide |
Lasix |
N/A |
N/A |
|
|
Hydrodiuril |
Hydrochlorothiazide |
N/A
|
N/A
|
|
|
Lisinopril |
Zestoretic |
N/A |
N/A |
|
|
Spironolactone |
Aldactone |
N/A
|
N/A
|
|
|
Triamterene |
Nova-Triamzide |
N/A |
N/A |
|
|
Erythropoiesis Regulating Hormone (while on Drug Therapy) |
Epoetin Alfa |
Eprex |
|
|
|
|
HCV Drug Therapy |
Interferon alfa-2b |
Intron-A |
|
|
|
|
Peg-Interferon alfa-2a |
Pegasys |
|
|
|
|
Pegylated Interferon alfa-2b-Ribavirin |
Pegetron |
|
|
|
|
Ribavirin - Interferon
alfa-2b |
Rebetron |
|
|
|
|
Peg-Interferon alfa-2b |
Unitron PEG |
|
|
|
|
Telaprevir |
Incivek |
|
|
|
|
Boceprevir |
Victrelis |
|
|
|
|
Sofosbuvir |
Sovaldi |
|
|
|
|
Simeprevir |
Olysio |
|
|
|
|
Harvoni |
Harvoni |
|
|
|
|
Holkira Pak |
Holkira Pak |
|
|
|
|
Technivie |
Technivie |
|
|
|
|
Daklinza |
Daklinza |
|
|
|
|
Zepatier |
Zepatier |
|
|
|
|
Epclusa |
Epclusa |
|
|
|
|
Vosevi |
Vosevi |
|
|
|
|
Maviret |
Maviret |
|
|
|
|
Hematopoietic Agents |
Filgrastim |
Neupogen |
N/A
|
N/A
|
|
|
Hyperuricemia |
Allopurinol |
Allopurinol |
N/A |
N/A |
|
|
Hypothyroidism Therapy |
Levothyroxine Sodium |
Eltroxin |
|
|
|
|
Immunosuppressive |
Sirolimus |
Rapamune |
N/A |
N/A |
N/A |
|
Laxative |
Psyllium Hydrophilic Mucilloid |
Metamucil |
|
|
|
|
Migraine Therapy (during Pegetron treatment and after liver transplant) |
Rizatriptan Benzoate |
Maxalt |
|
|
|
|
Nocturnal leg cramps |
Quinine Sulfate |
Quinine Sulfate |
N/A |
N/A |
|
|
Nonsteroidal Anti-Inflammatory
Agents(or other similar anti-inflammatory agents |
ASA |
Novasen |
|
|
|
|
Celecoxib |
Celebrex |
|
|
|
|
Diclofenac Sodium |
Voltaren |
|
|
|
|
Hydroxychloroquine Sulfate |
Plaquenil |
|
|
|
|
Ibuprofen |
Motrin |
|
|
|
|
Indomethacin |
Indocid |
|
|
|
|
Ketoprofen |
Orudis |
|
|
|
|
Ketorolac |
Toradol |
|
|
|
|
Meloxicam |
Mobicox |
|
|
|
|
Naproxen |
Naprosyn |
|
|
|
|
Piroxicam |
Feldene |
|
|
|
|
Hydroxychloroquine Sulfate |
Plaquenil |
|
|
|
|
Rofecoxib |
Vioxx |
|
|
|
|
Tolmetin Sodium |
Tolectin |
|
|
|
|
Ophtalmic Insert (Sjögren's Syndrome) |
Hydroxypropyl Cellulose |
Lacrisert |
|
|
|
|
Peristaltic Stimulant |
Docusate Sodium |
Senekot |
N/A
|
N/A
|
|
|
Portal-Systemic Encephalopathy Therapy - Laxative |
Lactulose |
Acilac |
N/A |
N/A |
|
|
Reflux Therapy |
Aluminum Hydroxide |
Gaviscon |
|
|
|
|
Cimetidine |
Tagamet |
|
|
|
|
Domperidone Maleate |
Apo-Domperidone |
|
|
|
|
Esomeprazole |
Nexium |
|
|
|
|
Famotidine |
Pepcid AC |
|
|
|
|
Lansoprazole |
Prevacid |
|
|
|
|
Magnesium Carbonate |
Maalox |
|
|
|
|
Magnesium Hydroxide |
Mylanta |
|
|
|
|
Metoclopramide Hydrochloride |
Apo-Metoclop |
|
|
|
|
Nizatidine |
Axid |
|
|
|
|
Omeprazole Magnesium |
Losec |
|
|
|
|
Pantoprazole Sodium |
Pantoloc |
|
|
|
|
Pinaverium Bromide |
Dicetel |
|
|
|
|
Rabeprazole Sodium |
Pariet |
|
|
|
|
Ranitidine Hydrochloride |
Zantac |
|
|
|
|
Skeletal Muscle
Relaxant
|
Cyclobenzaprine Hydrochloride |
Flexeril |
|
|
|
|
Synthetic Octapeptide |
Octreotide Acetate |
Sandostatin |
|
|
|
|
Supplements |
Boost |
|
|
|
|
|
Ensure |
|
|
|
|
|
Pedialyte |
|
|
|
|
|
Topical Anaesthetic for Dermal Analgesia |
Lidocaine-Prilocaine |
Emla Cream |
N/A |
N/A |
N/A |
|
Vaccinations
**Vaccines for hepatitis A and B can now be reimbursed at levels 1 & 2** |
Hepatitis A |
Havrix |
|
|
|
|
Hepatitis B |
Engerix / Recombivax |
 |
 |
 |
|
Hepatitis A and Hepatitis B |
Twinrix |
|
|
|
|
Influenza |
|
|
|
|
|
Pneumococcal Vaccine |
Pneumovax |
|
|
|
|
Vitamins |
Cyanocobalamin |
Vitamin B12 |
N/A |
N/A |
N/A |
|
Vitamin C |
|
N/A |
N/A |
|
|
Vitamin D |
|
N/A |
N/A |
|
|
Vitamin E |
|
N/A |
N/A |
|
|
Multi-vitamins |
|
N/A |
N/A |
 |
|