Hep C Drugs: Not Always Covered

There has been much concern that the high cost of the new generation of antivirals that treat hepatitis C would mean many patients will not get them.

A Detroit, MI study presented May 19 at the 2015 Digestive Disease Week conference in Washington, DC, by researchers from Henry Ford Hospital found that is not the case. But the team also found disparities in coverage based both on provider and the drugs prescribed.

Khalid George, MD and colleagues at the hospital’s department of gastroenterology and hepatology looked at 398 patients prescribed a regimen of sofosbuvir (Sovaldi/Gilead). Of these patients, 258 were prescribed sofosbuvir and ribavirin with or without interferon. A second group of 140 patients were prescribed sofosbuvir with simeprevir (Olysio/Janssen Therapeutics).

The major of patients (92%) had private insurance and 5.8% had Medicare coverage and 2.5% had Medicaid coverage.

Patients in the group getting sofosbuvir plus ribavirin (Rebetol/Merck) had a prescription approval rate of 83% if they had private coverage, but Medicare approved the prescriptions only 67% of the time and Medicaid paid 80% of the bills for its patients who got those prescriptions.

In the group prescribed sofosbuvir with simeprevir, private insurers approved 79% of the prescriptions, Medicare 63%, and Medicaid 78%.

The private insurers were less likely than Medicare and Medicaid to require prior authorization for patients to get their medications.

“Our results demonstrate that specific insurance types can lead to disparities in access to therapy for hepatitis C,” the team concluded.