2015 APHA Annual Meeting & Expo

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Recorded Annual Meeting Presentations (RAMP) are now available for purchase.
Only $90 for presenters, $140 for registered attendees and $200 for non-attendees.

Online Program

333376
Access to New Medications for Hepatitis C for Medicaid Members


Monday, November 2, 2015 : 3:30 p.m. - 3:50 p.m.

Karen Clements, ScD, Center for Health Policy & Research, University of Massachusetts Medical School, Shrewsbury, MA
Robin Clark, PhD, Dept. of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA
Pavel Lavitas, PharmD, BCPS, Clinical Pharmacy Services, University of Massachusetts Medical School
Parag Kunte, MPH, Center for Health Policy & Research, University of Massachusetts Medical School, Shrewsbury, MA
Camilla Graham, MD, Division of Infectious Diseases, Beth Israel Deaconess Medical Center
Elizabeth O'Connell, MS, Center for Health Policy & Research, University of Massachusetts Medical School, Shrewsbury, MA
Kimberly Lenz, PharmD, Office of Clinical Affairs, University of Massachusetts Medical School
Paul Jeffrey, PharmD, Office of Clinical Affairs, University of Massachusetts Medical School
Audio (mp3) recording Recorded Presentation (mp4)
Background:Sofosbuvir and simeprevir are highly effective for treating chronic hepatitis C virus (HCV) infection but are expensive. Medicaid programs have high HCV prevalence among enrollees and have implemented prior authorization (PA) requirements to ensure that patients who can benefit most have priority for these medications.  To better understand patient prioritization, we examined characteristics associated with PA requests for sofosbuvir or simeprevir among Massachusetts Medicaid (MassHealth) members with HCV.  

Methods: Claims for MassHealth Primary Care Clinician plan members continuously enrolled 12/6/2013–7/30/2014 with an ICD-9 code for HCV 12/6/2012–7/31/2014 were linked to PA request data. Demographic and clinical characteristics were compared using chi-square statistics. 

Results: Of 7,658 members with HCV, 379 (5.0%) had a PA request submitted to MassHealth; 90% were approved.  A significantly higher percentage of men (5.5%) had a request vs. women (4.3%). Requests were higher for ages ≥ 50 (6.7%) vs. <50 (3.2%) and diagnosis of liver disease, including hepatic decompensation, cancer, and transplant (10.1%) vs. no diagnosis (3.0%), and lower for those with opioid use (3.5%), other drug use (3.4%), or homelessness (2.6%) vs. those without (6.3%, 6.3%, 5.4%, respectively).  

Conclusions: Antiviral treatment was requested for a relatively small proportion of MassHealth members with HCV, with 90% of PAs approved. Prescriber prioritization, rather than the PA process, is determining  access to treatment. Per treatment guidelines, requests were higher for those with a liver disease diagnosis. Support may be needed to ensure patients with substance use or homelessness also benefit from advances in HCV treatment.

Learning Areas:

Chronic disease management and prevention
Provision of health care to the public
Public health or related public policy
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Describe the percentage of Massachusetts Medicaid members whose physicians requested prior authorization for new hepatitis medications and the percentage of requests approved. Identify characteristics associated with prior authorization requests.

Keyword(s): Hepatitis C, Medicaid

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principal investigator of the current project, which uses Massachusetts Medicaid data to evaluate treatment patterns, adherence, and cost of new HCV medications in a Medicaid population. I have led the study design and analysis effort for the results presented in this abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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