Original articlePancreas, biliary tract, and liverDisparities in Absolute Denial of Modern Hepatitis C Therapy by Type of Insurance
Section snippets
Study Design and Data Source
We conducted a prospective cohort study using data from Burman’s Specialty Pharmacy, which provides HCV pharmacy services to community and academic medical practices across Delaware, Maryland, New Jersey, and Pennsylvania. DAAs often are dispensed by specialty pharmacies because of their high costs and requirements for special handling and delivery.17 Burman’s Specialty Pharmacy obtains medical information from clinicians to complete the prior authorization request and submits the prescription
Study Patients
Between November 1, 2014 and April 30, 2015, Burman’s Specialty Pharmacy received DAA prescriptions for 3791 patients. After exclusions (Figure 1), 2342 patients remained. Among these, 21 (0.9%) patients had an incomplete prior authorization after 60 days and were excluded, leaving 2321 patients (503 with Medicaid [492 (97.8%) with Medicaid managed care and 11 (2.2%) with Medicaid fee-for-service], 795 with Medicare, and 1023 with commercial insurance). Medicaid patients were younger, more
Discussion
In this study of chronic HCV-infected patients prescribed DAA-based HCV therapy across Delaware, Maryland, New Jersey, and Pennsylvania between November 2014 and April 2015, 16% were absolutely denied treatment by their insurance carrier. Notably, 46% of Medicaid beneficiaries from these states did not have their prescription approved for fill, and this was substantially higher than patients with Medicare or commercial insurance. The disparity was even more evident among patients with
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2021, American Journal of Preventive MedicineCitation Excerpt :The reduction in prescriptions may have continued beyond the time that HCV screening has returned to near previous levels, owing to the time for patient referral to specialists and appointment scheduling, prescription authorization, and patient delays in seeking and obtaining appointments and authorizations.22 Factors influencing prescription administration delays include insurance coverage,23,24 racial and ethnic disparities,25,26 and substance use.27 Nevertheless, delays in diagnosis may result in significant delays in treatments.
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2021, Computers in Biology and MedicineCitation Excerpt :This may be because clinical guidelines to decrease HCV-related morbidity and mortality recommend HCV treatment for patients with advanced liver disease [10,14,15], and approval by insurance companies for treatment is related to disease state [46,47]. Cirrhosis has been associated with higher rates of virologic cure [48], and patients with severe liver disease are often prioritized for initiating antiviral treatment [41,49]. In our study, more patients who achieved the final outcome, virologic cure, had a medical diagnosis of transplanted liver than did patients who were not cured.
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2021, American Journal of Preventive MedicineCitation Excerpt :Medicare also offers higher payments to rural health providers to improve healthcare access and quality of care for their rural beneficiaries.33 Nonetheless, DAA utilization in Medicare patients is low, and the national specialty pharmacy cohort studies also show that denial of DAAs by Medicare has increased by 10% over time (5% in 2014–2015 vs 14.7% in 2016–2017).10,12,13,34,35 These patterns may be caused by increasing demand for expensive DAA treatment that led to restrictive reimbursement or utilization policies.
Conflicts of interest These authors disclose the following: Vincent Lo Re has received investigator-initiated research grant support (to the University of Pennsylvania) from AstraZeneca; Jody Gilmore has served on the advisory boards of AbbVie, Bristol-Myers Squibb, and Gilead Sciences; Jalpa Doshi has served on the advisory boards of Alkermes, Boehringer Ingelheim, Forest, Ironwood Pharmaceuticals, Merck, and Shire, has received research grant support (to the University of Pennsylvania) from Amgen, Merck, Pfizer, PhRMA, and the National Pharmaceutical Council, and has a spouse who holds stock in Merck and Pfizer; Peter Reese has received investigator-initiated research grant support from Merck; K. Rajender Reddy has served on the advisory boards of Merck, AbbVie, Bristol-Myers Squibb, Gilead Sciences, and Janssen, and has received research grant support (to the University of Pennsylvania) from AbbVie, Bristol-Myers Squibb, Gilead Sciences, Janssen, and Merck; Jay Kostman has served on the advisory board of Gilead Sciences; and Paul Urick, Joshua Halladay, Kathryn Battista, and Cassandra Peleckis are employees of Burman’s Specialty Pharmacy. The remaining authors disclose no conflicts.
Funding This research was supported by grant funding from the Penn Center for AIDS Research, a National Institutes of Health–funded program (P30 AI 045008). The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.