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Improving Access to HCV Medications

J Manag Care Spec Pharm; 2018 Apr; Vu, et al

Non-Medicaid insurance, older age, and female gender were among the factors found to have a positive impact in relation to fewer steps in obtaining prior authorization (PA) approval for new direct-acting antiviral (DAA) hepatitis C virus (HCV) medications, a recent study found. The review looked at program databases and medical records of patients for whom hepatitis C medications were ordered between November 1, 2014, and October 31, 2015 (n=197). Patient characteristics associated with the number of steps to approval were evaluated; independent predictors of fewer steps to approval were then determined. Researchers found:

  • Of the 197 patients, 136 (69%) had Medicaid, 24 (12%) had Medicare, 19 (10%) had both Medicaid and Medicare, 10 (5%) had private insurance, and 8 (4%) were uninsured.
  • 93% of the patients were eventually approved for HCV treatment.
  • The steps in the PA cascade were approval on first submission (37%; mean days = 30.7; SD = 29.9); approval after internal appeal (45%; mean days = 66.8, SD = 70.5); and no approval obtained (7%).
  • Unadjusted factors found to have a P value <0.200 in relation to fewer steps to approval were older age, female gender, non-Medicaid insurance, comorbid hypertension, comorbid diabetes, and being nongenotype 2.


Vu TM, Toribio W, Riazi F, et al. Increasing access to hepatitis C virus medications: A program model using patient navigators and specialty pharmacy to obtain prior authorization approval. J Manag Care Spec Pharm. doi:10.18553/jmcp.2018.24.4.329.