Abstract
Medicaid enrolls a disproportionate share of US adults with hepatitis C virus (HCV), and most receive Medicaid benefits through managed care organizations (MCOs). Medicaid MCOs often impose stricter requirements to access HCV medications than traditional fee-for-service Medicaid, which may inhibit use. Though Medicaid MCOs generally cover prescription drugs, several states have carved out direct-acting antiviral HCV medications from MCO coverage and opted to cover them under fee-for-service. Whether these carve outs were associated with changes in medication use is unknown. To examine the association between Medicaid-covered HCV medication fills and carve outs of these medications from MCO coverage. This cross-sectional study examined changes in fills of Medicaid-covered direct-acting antiviral HCV medications in 4 states (Indiana, Michigan, New Hampshire, and West Virginia) that carved out these drugs from Medicaid MCOs between 2015 and 2017. A synthetic control approach was used to compare changes in HCV prescription fills between states that did and did not carve out these medications from MCO prescription drug coverage. Data of direct-acting antiviral HCV prescription fills were obtained from the Medicaid State Drug Utilization Data files, January 2015 to June 2020. Data analysis was conducted from November 2020 to June 2021. Carve outs of direct-acting antiviral HCV medications from Medicaid MCO prescription drug coverage. Direct-acting antiviral HCV prescriptions filled per 100 000 Medicaid enrollees. In this cross-sectional study, carve outs were associated with a mean quarterly increase of 22.1 (95% CI, 12.7-34.1) HCV prescriptions per 100 000 Medicaid enrollees, a relative increase of 86.3% compared with synthetic control states. Compared with each state's respective synthetic control, HCV prescription fills were associated with an increase of 11.5 (95% CI, 5.1-19.0) HCV prescription fills per 100 000 Medicaid enrollees per quarter in Indiana, 36.6 (95% CI, 23.5-53.9) in Michigan, 20.7 (95% CI, 11.1-32.8) in West Virginia, and 43.6 (95% CI, 25.9-68.4) in New Hampshire. In this cross-sectional study of data from 39 states and the District of Columbia, carve outs of direct-acting antiviral HCV medications from Medicaid MCO prescription drug coverage were associated with significant increases in HCV medication use. Given their clinical benefits, greater uptake of HCV medication may help improve the health of Medicaid enrollees with HCV and reduce the economic burden of untreated HCV on the US health care system.
Highlights
An estimated 4.1 million people are infected with the hepatitis C virus (HCV) in the US, and the prevalence of HCV is disproportionately higher among those enrolled in Medicaid.[1,2] Since late 2013, the use of highly active direct-acting antivirals has revolutionized the treatment of HCV.[3]
Compared with each state’s respective synthetic control, HCV prescription fills were associated with an increase of 11.5 HCV prescription fills per 100 000 Medicaid enrollees per quarter in Indiana, 36.6 in Michigan, 20.7 in West Virginia, and 43.6 in New Hampshire
In this cross-sectional study of data from 39 states and the District of Columbia, carve outs of direct-acting antiviral HCV medications from Medicaid managed care organizations (MCOs) prescription drug coverage were associated with significant increases in HCV medication use
Summary
An estimated 4.1 million people are infected with the hepatitis C virus (HCV) in the US, and the prevalence of HCV is disproportionately higher among those enrolled in Medicaid.[1,2] Since late 2013, the use of highly active direct-acting antivirals has revolutionized the treatment of HCV.[3] In contrast with earlier HCV treatments, these newer medications are well tolerated and often curative after 1 course of treatment.[4] The Infectious Diseases Society of America and American Association for the Study of Liver Diseases recommend treatment for all patients with acute or chronic HCV infection regardless of stage of infection.[5] Timely treatment of HCV may avoid negative health consequences and reduce the economic burden of untreated HCV in the US health care system.[2] Despite the effectiveness of HCV medications, state Medicaid programs often limit access to HCV medications because of their high cost, with list prices ranging from $25 000 to $95 000 for a single course of treatment.[6,7] Historically, access to HCV treatment was limited through prior authorization requirements and restrictions requiring advanced liver damage and abstinence from use of substances.[8] Despite access restrictions, HCV medications accounted for 5.1% of gross Medicaid spending on outpatient drugs ($3.2 billion) but only 0.02% of prescriptions in 2017.9
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
