The Prescribers’ Dilemma: Treatment of Hepatitis C Infection for Medicaid Insured Patients in United States
Introduction of Direct Acting Antivirals to Hepatitis C Virus treatment armamentarium
has offered a great boost to the providers’ confidence to safely and effectively
treat HCV infection in the majority of patients.
However, the cost of these medications is high
and thus access is poor. Medicaid insurance providers have devised stringent eligibility criteria
to approve the cost of DAA for its members. We reviewed the criteria among various Medicaid
agencies from States of Ohio and Pennsylvania and noticed similarities and differences among them.
The prerequisite process demanding clinical, laboratory, radiologic or histologic documentation is quite cumbersome and sometimes confusing. In certain aspects the eligibility requirements for DAA are not in concordance with the clinical evidence provided by the recently updated guidelines.
We have addressed the dilemma most of the providers face while planning
HCV treatment for the Medicaid insured patients in regards to the needed testing,
clinical documentation and liver fibrosis assessment, along with the clinical implications
of such requirements.
While HCV remains a major public health issue, variable State Medicaid policies may
lead to disparity in access to the emerging DAA with subsequent healthcare outcomes.
These gaps may compromise long term efforts of the public health HCV initiatives.
It is estimated that 3.5 million people living in the United States (US) are exposed
to chronic Hepatitis C Virus (HCV), with many cases remaining to be diagnosed.
The 2013 United States Preventive Services Task Force (USPSTF) recommends a onetime screening for
HCV infection in adults born between 1945-1965 based on evidence indicating proven benefits
of chronic HCV treatment in the reduction of all-cause mortality.
Liver Res Open J. 2015; 1(2): 26-31. doi: 10.17140/LROJ-1-105
