A UMass Medical School study of Massachusetts Medicaid members suggests certain patients with hepatitis C face barriers to receiving the newest medications to treat the virus. The research paper published in the June edition of the Journal of Managed Care & Specialty Pharmacy says more patients must have access to the life-saving regimens.
"In order to reduce future health care costs and premature mortality associated with HCV (chronic hepatitis C virus), the number of patients receiving these potentially curative antiviral treatments must be increased," the authors said. "This study suggests that there are barriers to treatment access in addition to the high cost of these medications that will have to be addressed in order to achieve this goal."
The paper, Access to New Medications for Hepatitis C for Medicaid Members: A Retrospective Cohort Study, examined the use of sofosbuvir and simeprevir, expensive medications that have been very effective treating HCV, among members of MassHealth, Massachusetts’ Medicaid program.
HCV, a bloodborne infection that can cause severe liver disease, affects 3 million to 6 million people, or 1 to 2 percent of the U.S. population. It occurs most often in individuals with substance use disorder and more than half are intravenous drug users, the authors said in the paper.
The study found use of the medications did not increase as quickly as expected considering MassHealth has few restrictions on treatment access as compared to other states, and treatment referral was varied. People with substance use disorders, who comprise a large portion of those with HCV, were less likely to have treatment requested than MassHealth members with more advanced liver disease, according to the authors.
Several barriers to treatment were outlined by the authors, including:
- Payers being concerned about having enough resources for all who request treatment.
- Nearly all state Medicaid programs require prior authorization for sofosbuvir and simeprevir because of limited budgets.
- Some patients may have difficulty adhering to treatment regimens.
- Physicians may not want to treat patients they consider poor risks.
Despite the high cost of the drugs, the authors said, they may be a good value because they can reduce complications and health care costs, and improve the quality of life for people with HCV.
The co-authors from UMass Medical School’s Commonwealth Medicine division are: Karen M. Clements, ScD, MPH, Parag Kunte, MPH, and Elizabeth O’Connell, MS, all of the Center for Health Policy and Research; Pavel Lavitas, PharmD, BCPS, of Clinical Pharmacy Services; and Kimberly Lenz, PharmD, and Paul Jeffrey, PharmD, both of the Office of Clinical Affairs. Additional co-authors are Robin E. Clark, PhD, of UMass Medical School’s Department of Family Medicine and Community Health, and Camilla S. Graham, MD, MPH, of the Division of Infectious Diseases, Beth Israel Deaconess Medical Center.