Study Looks at Barriers to Hepatitis C Treatment

Beyond high cost, people with hepatitis C face several barriers to treatment, and those arise from various sources. Doctors, Medicaid, private health insurance companies, and intravenous drug use can all be obstacles, according to a university study out of Massachusetts that examined treatment approvals for two new drugs.

Researchers looked at access through the lens of the Massachusetts Medicaid Program (MassHealth) by analyzing prior approval requests for sofosbuvir and simeprevir hepatitis C treatments. Results of the study, led by Karen Clements, assistant professor of quantitative health sciences at the University of Massachusetts Medical School and a senior project director in Commonwealth Medicine, was published in the June edition of the Journal of Managed Care & Specialty Pharmacy.

New medications to treat hepatitis C have improved cure rates but are more expensive than traditional therapies, noted the authors. Given that most state Medicaid programs require prior authorization for new medicines, they sought to evaluate the percentage of MassHealth patients with hepatitis C who requested and received approval for treatment using sofosbuvir or simeprevir, two of the new drugs used to treat the virus.

The authors noted that other barriers exist outside of cost and insurance requirements.

“For example, some potential patients may not have a regular source of care or may have difficulty adhering to treatment regimens because of medical or social conditions such as SUD (substance use disorder) or unstable housing,” stated the authors. “Physicians, too, may be reluctant to treat patients whom they perceive to be poor risks for achieving successful outcomes.”

The findings indicate that hepatitis C treatment referrals varied and that medication use did not increase as quickly as expected, even though MassHealth has few restrictions on treatment access. Antiviral treatment with the two drugs was requested for a relatively small proportion of the afflicted MassHealth members, and nearly all were approved, according to the article.

The review did not look at other states, but the authors believe that the percentage of eligible patients who are treated is similar or lower because many other states have stiffer requirements. The results suggest that there could be a large group of untreated patients who could benefit from new treatment and may request it in the future, the authors stated.

Health officials estimate that at least 3 million people in the US have hepatitis C, a blood borne virus that can seriously damage the liver over time. Public health campaigns have encouraged testing among high-risk groups because a common lack of symptoms means it’s possible to have chronic infection of the virus and not know it.

The fastest growing number of new cases of hepatitis C are among people who are intravenous drug users. The study found that people with substance use disorders were less likely to have requested treatment than MassHealth members with advanced liver disease.

“In order to reduce future health care costs and premature mortality associated with HCV [chronic hepatitis C virus], the number of patients receiving these potentially curative antiviral treatments must be increased,” stated the authors. “This study suggests that there are barriers to treatment access in addition to the high cost of these medications that will have to be addressed in order to achieve this goal.”