Factors Associated With Delay in Therapy for Chronic Hepatitis C

Rice, Donald T.; Ordoveza, Michelle; Palmer, Ann; Wu, George; Chirch, Lisa M.

doi:10.1093/ofid/ofw172.1692

Cited by 2 publications

(3 citation statements)

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“…However, the majority of these lawsuits were directed at government‐based PBMs, and expansion of coverage remained limited to Medicare/Medicaid PBMs while the authorization process for DAA therapy by commercial PBMs remained more nebulous. As a result of legal challenges to reimbursement policies, more recent data have demonstrated superior access to DAAs for those with government‐based PBMs compared to commercial PBMs 21,22 . This experience is in line with what we see with D+/R− kidney transplantation.…”

Section: Discussionsupporting

confidence: 69%

Commercial insurance delays direct‐acting antiviral treatment for hepatitis C kidney transplantation into uninfected recipients

Torabi

Rocca

Ajaimy

et al. 2020

Transplant Infectious Dis

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Introduction The advent of direct‐acting antivirals (DAAs) has created an avenue for transplantation of hepatitis C virus (HCV)‐infected donors into uninfected recipients (D+/R−). The donor transmission of HCV is then countered by DAA administration during the post‐operative period. However, initiation of DAA treatment is ultimately dictated by insurance companies. Methods A retrospective chart review of 52 D+/R− kidney recipients who underwent DAA treatment post‐transplant was performed. Patients were grouped according to their prescription coverage plans, managed by either commercial or government pharmacy benefit managers (PBMs). Results Thirty‐nine patients had government PBMs and 13 had commercial PBMs. Demographics were similar between the two groups. All patients developed HCV viremia, but cleared the virus after treatment with DAA. Patients with government PBMs were treated earlier compared to those with commercial PBMs (11 days vs 26 days, P = .01). Longer time to DAA initiation resulted in higher peak viral loads (β = 0.39, R2 = .15, P = .01) and longer time to HCV viral load clearance (β = 0.41, R2 = .17, P = .01). Conclusions D+/R− transplantation offers patients an alternative strategy to increase access. However, treatment can be profoundly delayed by a third‐party payer authorization process that may be subjecting patients to unnecessary risks and worsened outcomes.

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Section: Discussionsupporting

confidence: 69%

Commercial insurance delays direct‐acting antiviral treatment for hepatitis C kidney transplantation into uninfected recipients

Torabi

Rocca

Ajaimy

et al. 2020

Transplant Infectious Dis

View full text Add to dashboard Cite

show abstract

“…9 In another chart review, average TtT was 31 days (median 23 days, interquartile range 14 to 35 days). 23 Rice et al identified some factors associated with shorter TtT, including infectious diseases clinic management (28 vs. 45 days), absence of other liver disease (28 vs. 61 days), having a public insurance payer (28 vs. 50 days), and initial approval of requested regimen (26 vs. 102 days). 23 In comparison, our study found longer TtT for DAA authorization of initial denials, patients with Medicaid, and specific regimens.…”

Section: Discussionmentioning

confidence: 99%

“…23 Rice et al identified some factors associated with shorter TtT, including infectious diseases clinic management (28 vs. 45 days), absence of other liver disease (28 vs. 61 days), having a public insurance payer (28 vs. 50 days), and initial approval of requested regimen (26 vs. 102 days). 23 In comparison, our study found longer TtT for DAA authorization of initial denials, patients with Medicaid, and specific regimens. Given our small sample with delayed access to therapy and our observational study design, we could not confirm which factors were linked to lower SVR, but future research should consider such hypotheses.…”

Section: Discussionmentioning

confidence: 99%