Updated: JUNE 6, 2018 —
8:06 PM EDT
Hepatitis C patients
are routinely being denied access to life-saving medication at a time when the
liver disease is on the rise, especially among intravenous drug users,
according to new analysis by researchers at the University of Pennsylvania’s
Perelman School of Medicine.
The number of new
reported cases of acute hepatitis C in Pennsylvania soared 240 percent between
2012 and 2016, to 225, according to the U.S. Centers for Disease Control and
Prevention, which the agency linked to a rise in injected-drug use. Yet
according to the university study released Thursday, many patients may not be
getting the treatment they need.
Half of patients with
private insurance were denied coverage for the pill regimen, which can cost
tens of thousands of dollars, according to a review of thousands of
prescription claims between January 2016 and April 2017. Across all payers,
including Medicare and Medicaid, 35 percent of prescriptions for the treatment
were denied.
“Despite effective
hepatitis C drugs and despite attention paid toward restrictions in access to
drugs, denials are still common,” said Vincent Lo Re III, an associate
professor of infectious disease and epidemiology at Penn and a senior author of
the study. “If we’re going to hope to eliminate hepatitis C as a public health
problem, we need to improve access to antiviral drugs.”
“Eliminating hep C is
a feasible goal but that’s going to be hard to achieve if payers are not
reimbursing for the treatment,” he added in a statement.
The newest generation
of hep C drugs, which debuted in 2014, has revolutionized treatment, making it
far more successful. But the drugs’ high cost has prompted insurers to restrict
coverage to just patients with advanced stages of the liver infection.
Most treatments
involve taking a pill once a day for 8 to 12 weeks, and cost $35,000 to
$95,000.
In smaller studies
shortly after the drugs became available in 2014, the researchers found that 8
percent to 16 percent of prescriptions were being denied.
Since then, several
states — including Pennsylvania — have loosened restrictions for Medicaid
patients in response to pressure from advocates and the threat of class-action
lawsuits.
As of January,
Medicaid covers hepatitis C treatment for
all Pennsylvania patients. The program used to limit coverage to patients
showing signs of liver damage.
Researchers had
hypothesized that greater awareness, loosening of restrictions, and greater
drug competition would improve access to treatment since their last study, Lo
Re said. But it hasn’t worked out that way.
Their analysis of
prescriptions from 9,025 patients in 45 states over a 16-month period ending
April 2017 submitted to Diplomat Pharmacy Inc., which provides pharmacy
services across the country, showed otherwise:
- Overall, 35.5 percent of prescriptions – a total of
3,200 prescriptions – were denied.
- Commercial insurance had the highest denial rates, with
52.4 percent of patients denied coverage
- Medicaid denied 34.5 percent of prescriptions and
Medicare denied 14.7 percent of requests.
Pennsylvania accounted
for about 31.5 percent of all prescriptions analyzed by researchers.
Here, 45.7 percent of
prescriptions were denied. Medicaid denied 52.2 percent of prescriptions in
Pennsylvania, far outpacing the national rate. The study period predated the
state’s new regulations.
Medicare and private
insurance denial rates in Pennsylvania were in line with the national trend.
Lo Re said it was not
clear in the data why prescriptions were denied because insurers did not report
a reason to Diplomat.
Independence Blue
Cross, the region’s largest insurer, did not respond to a request for comment
in time for publication.
Jack Hildick-Smith,
co-chair of the Hepatitis C Allies of Philadelphia, said he’s optimistic that
the state’s new Medicaid policy for hepatitis C treatment will improve access
to patients, but there’s still much work to be done, especially as infection
rates rise in tandem with the city’s opioid epidemic.
“Now that the policies
have changed, it would be great to see hep C treatment become more integrated
into primary care – which would make access much easier for patients,” Hildick-Smith
said in an email. “In particular, given the scope of Philadelphia’s opioid
crisis and the fact that stigma can make health care access challenging for
many people with a history of drug use, having treatment available in settings
where people feel comfortable is important.”
Published: June 7, 2018 —
1:00 AM EDT
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