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Medicaid hepatitis c

Joshua M Liao, Michael A Fischer
Medicaid programs provide health insurance coverage for many patients with hepatitis C, a public health problem for which effective but very expensive treatments are now available. Facing constrained budgets, most states adopted prior authorization criteria for sofosbuvir, the first of these agents. Using fee-for-service utilization data from 42 Medicaid programs in 2014, we found that strict behavioral criteria-those that limited coverage on the basis of drug or alcohol use and included specific abstinence or treatment requirements-were associated with significantly less spending on sofosbuvir...
April 20, 2017: American Journal of Public Health
Kohtaro Ooka, James J Connolly, Joseph K Lim
No abstract text is available yet for this article.
April 4, 2017: American Journal of Gastroenterology
Neeta K Venepalli, Mary V Modayil, Stephanie A Berg, Tad D Nair, Mayur Parepally, Priyanka Rajaram, Ron C Gaba, James T Bui, Yue Huang, Scott J Cotler
AIM: To compare features of hepatocellular carcinoma (HCC) in Hispanics to those of African Americans and Whites. METHODS: Patients treated for HCC at an urban tertiary medical center from 2005 to 2011 were identified from a tumor registry. Data were collected retrospectively, including demographics, comorbidities, liver disease characteristics, tumor parameters, treatment, and survival (OS) outcomes. OS analyses were performed using Kaplan-Meier method. RESULTS: One hundred and ninety-five patients with HCC were identified: 80...
March 8, 2017: World Journal of Hepatology
Zobair Younossi, Stuart C Gordon, Aijaz Ahmed, Douglas Dieterich, Sammy Saab, Rachel Beckerman
OBJECTIVES: To estimate change in chronic hepatitis C virus (HCV) disease and the economic burden associated with comprehensive treatment of the chronic HCV-infected Medicaid population. STUDY DESIGN: Decision-analytic Markov model. METHODS: Treatment-naïve patients with genotype 1 chronic HCV were followed over a lifetime horizon from the third-party payer perspective. Patients entered the model insured under Medicaid and were treated under state-specific restrictions by Metavir fibrosis stage (base case) or all treated (all-patient strategy) with an approved all-oral regimen (ledipasvir/sofosbuvir [LDV/SOF] for 8 weeks or 12 weeks, depending on cirrhosis status, viral load, and state-specific LDV/SOF restrictions)...
February 2017: American Journal of Managed Care
Mina Kabiri, Jagpreet Chhatwal, Julie M Donohue, Mark S Roberts, A Everette James, Michael A Dunn, Walid F Gellad
BACKGROUND: Several highly effective but costly therapies for hepatitis C virus (HCV) are available. As a consequence of their high price, 36 state Medicaid programs limited treatment coverage to patients with more advanced HCV stages. States have only limited information available to predict the long-term impact of these decisions. METHODS: We adapted a validated hepatitis C microsimulation model to the Pennsylvania Medicaid population to estimate the existing HCV prevalence in Pennsylvania Medicaid and estimate the impact of various HCV drug coverage policies on disease outcomes and costs...
December 5, 2016: Healthcare
Pavel Lavitas, Mark Tesell, Tasmina Hydery, Bonnie C Greenwood, Mylissa Price, Kimberly Lenz, Paul Jeffrey
BACKGROUND: Breakthrough direct-acting antivirals set a new standard in the management of hepatitis C virus (HCV) with regard to cure rates and improved tolerability; however, the health care system is challenged by the cost of these medications. OBJECTIVE: To describe the effect of a comprehensive HCV medication management program on optimized regimen use, prior authorization (PA) modifications, and medication cost avoidance in a state Medicaid program. METHODS: This program consists of a 2-tiered prescriber outreach: (1) regimen outreach to promote optimized regimen selection and (2) refill outreach to support medication adherence...
October 2016: Journal of Managed Care & Specialty Pharmacy
Kassem Bourgi, Indira Brar, Kimberly Baker-Genaw
With recommended screening for hepatitis C among the 1945-1965 birth cohort and advent of novel highly effective therapies, little is known about health disparities in the Hepatitis C care cascade. Our objective was to evaluate hepatitis C screening rates and linkage to care, among patients who test positive, at our large integrated health system. We used electronic medical records to retrospectively identify patients, in the birth cohort, who were seen in 21 Internal Medicine clinics from July 2014 to June 2015...
2016: PloS One
Monique A Foster, Jian Xing, Anne C Moorman, Joseph Boscarino, Stuart C Gordon, Mei Lu, Loralee Rupp, Mark A Schmidt, Connie M Trinacty, Fujie Xu, Scott D Holmberg, Philip R Spradling
BACKGROUND: Linking persons with hepatitis C virus (HCV) to care and treatment is critical to reduction in disease burden; typically, this entailed referral to a specialist. However, data regarding the frequency and factors associated with referral among patients in healthcare organizations (HCOs) are lacking. METHODS: Among persons in four US HCOs with newly diagnosed HCV during 2006-2011, we determined the frequency of liver-related specialist care after diagnosis...
August 10, 2016: Digestive Diseases and Sciences
A I Soipe, H Razavi, D Razavi-Shearer, O Galárraga, L E Taylor, B D L Marshall
We utilized a disease progression model to predict the number of viraemic infections, cirrhotic cases, and liver-related deaths in the state of Rhode Island (RI) under four treatment scenarios: (1) current HCV treatment paradigm (about 215 patients treated annually, Medicaid reimbursement criteria fibrosis stage ⩾F3); (2) immediate scale-up of treatment (to 430 annually) and less restrictive Medicaid reimbursement criteria (fibrosis stage ⩾F2); (3) immediate treatment scale-up and no fibrosis stage-specific Medicaid reimbursement criteria (⩾F0); (4) an 'elimination' scenario (i...
August 5, 2016: Epidemiology and Infection
Veronica Loy, Tamara Benyashvili, William Adams, Douglas Pavkov, Meghan O'Mahoney, Scott J Cotler
BACKGROUND: Obtaining direct-acting antiviral (DAA) medications for treatment of HCV is labour-intensive for providers. The purpose of this study was to assess the amount of unbillable time and to estimate the financial burden of obtaining DAAs for HCV. METHODS: Patients prescribed DAA therapy from 30 September 2014 to 19 March 2015 at an academic hepatology practice were enrolled prospectively. Providers recorded the amount of time required to obtain HCV therapy for each patient...
2016: Antiviral Therapy
Alexis P Chidi, Cindy L Bryce, Julie M Donohue, Michael J Fine, Douglas P Landsittel, Larissa Myaskovsky, Shari S Rogal, Galen E Switzer, Allan Tsung, Kenneth J Smith
BACKGROUND: Interferon-free hepatitis C treatment regimens are effective but very costly. The cost-effectiveness, budget, and public health impacts of current Medicaid treatment policies restricting treatment to patients with advanced disease remain unknown. OBJECTIVES: To evaluate the cost-effectiveness of current Medicaid policies restricting hepatitis C treatment to patients with advanced disease compared with a strategy providing unrestricted access to hepatitis C treatment, assess the budget and public health impact of each strategy, and estimate the feasibility and long-term effects of increased access to treatment for patients with hepatitis C...
June 2016: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
Rita Rubin
No abstract text is available yet for this article.
February 9, 2016: JAMA: the Journal of the American Medical Association
Karen M Clements, Robin E Clark, Pavel Lavitas, Parag Kunte, Camilla S Graham, Elizabeth O'Connell, Kimberly Lenz, Paul Jeffrey
BACKGROUND: Sofosbuvir (SOF)- or simeprevir (SIM)-containing regimens are highly effective for treating chronic hepatitis C virus (HCV) infection. These regimens, however, are expensive. Most payers have implemented prior authorization (PA) requirements to ensure that patients who can benefit most have priority for these medications. While many Medicaid programs limit access to those with advanced disease or to members who do not have active substance use disorder (SUD), the Massachusetts Medicaid (MassHealth) Primary Care Clinician (PCC) plan does not limit access based on disease severity or presence of SUD...
June 2016: Journal of Managed Care & Specialty Pharmacy
Vincent Lo Re, Charitha Gowda, Paul N Urick, Joshua T Halladay, Amanda Binkley, Dena M Carbonari, Kathryn Battista, Cassandra Peleckis, Jody Gilmore, Jason A Roy, Jalpa A Doshi, Peter P Reese, K Rajender Reddy, Jay R Kostman
BACKGROUND & AIMS: The high costs of direct-acting antiviral (DAA) agents to treat chronic hepatitis C virus (HCV) infection have resulted in denials of treatment, but it is not clear whether patients' access to these therapies differs with their type of insurance. METHODS: We conducted a prospective cohort study among all patients who had a DAA prescription submitted between November 1, 2014 and April 30, 2015 to Burman's Specialty Pharmacy, which provides HCV pharmacy services to patients in Delaware, Maryland, New Jersey, and Pennsylvania...
July 2016: Clinical Gastroenterology and Hepatology
Evan Trager, Mandana Khalili, Carmen L Masson, Eric Vittinghoff, Jennifer Creasman, Christina Mangurian
Although HCV is more prevalent among people with severe mental illness (SMI; e.g., schizophrenia, bipolar disorder) than in the general population (17% vs 1%), no large previous studies have examined HCV screening in this population. In this cross-sectional study, we examined administrative data for 57 170 California Medicaid enrollees with SMI to identify prevalence and predictors of HCV screening from October 2010 through September 2011. Only 4.7% (2674 of 57 170) received HCV screening, with strongest predictors being nonpsychiatric health care utilization and comorbid substance abuse...
April 2016: American Journal of Public Health
Z M Younossi, B R Bacon, D T Dieterich, S L Flamm, K Kowdley, S Milligan, N Tsai, A Nezam
Despite the clinical success in the real-world of all oral hepatitis C virus (HCV) therapy with response rates approaching that seen in the clinical trials, access has been limited by many payers with discussion of prioritization of treatment based upon AASLD guidelines. We evaluated patients in the TRIO network who were prescribed sofosbuvir (SOF)-based regimens to determine reasons for not starting treatment. Trio Health is a disease management company that works in partnership with academic medical centres, community physicians and specialty pharmacies in the United States to optimize care for HCV...
June 2016: Journal of Viral Hepatitis
Archita P Desai, Nancy Reau
Advanced liver disease is becoming more prevalent in the United States. This increase has been attributed largely to the growing epidemic of nonalcoholic fatty liver disease and an aging population infected with hepatitis C. Complications of cirrhosis are a major cause of hospital admissions and readmissions. It is important to target efforts for preventing rehospitalization toward patients with cirrhosis who are at the highest risk for readmission, such as those who have high Model for End-Stage Liver Disease scores, are at risk for fluid/electrolyte abnormalities or overt hepatic encephalopathy recurrence, and those who have comorbid conditions (e...
2016: Hospital Practice (Minneapolis)
Rebecca Cope, Thomas Glowa, Samantha Faulds, Deborah McMahon, Ramakrishna Prasad
Now that highly efficacious, interferon-free (IFN-free), direct acting antivirals (DAA) for the treatment of hepatitis C (HCV) have closed the gap between treatment and cure, identifying barriers that prevent initiation of treatment is more crucial than ever. This is a retrospective study utilizing Electronic Medical Records and Prior Authorization Records to identify HCV treatment gaps, including predictors for intention-to-treat and treatment initiation in the first 15 months of a Ryan White funded human immunodeficiency virus (HIV)/HCV co-infection clinic...
February 2016: AIDS Patient Care and STDs
Kathy K Byrd, Melissa Furtado, Tim Bush, Lytt Gardner
We used the US-based MarketScan(®) Medicaid Multi-state Databases to determine the un-weighted proportion of publically insured persons with HIV that were retained, continued, and re-engaged in care. Persons were followed for up to 84 months. Cox proportional hazards models were conducted to determine factors associated with gaps in care. Of the 6463 HIV cases identified in 2006, 61% were retained during the first 24 months, and 53% continued in care through 78 months. Between 8% and 30% experienced a gap in care, and 59% of persons who experienced a gap in care later re-engaged in care...
2015: AIDS Care
Patricia M Dietz, Michelle Van Handel, Huisheng Wang, Philip J Peters, Jun Zhang, Abigail Viall, Bernard M Branson
OBJECTIVE: To assess HIV testing and factors associated with receipt of testing among persons with Medicaid and commercial insurance during 2012. METHODS: Outpatient and laboratory claims were analyzed from two databases: all Medicaid claims from six states and all claims from Medicaid health plans from four other states and a large national convenience sample of patients with commercial insurance in the United States. We excluded those aged <13 years and >64 years, enrolled <9 of the 12 months, pregnant females, and previously diagnosed with HIV...
2015: PloS One
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