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.
This Week's Must Reads
Must Reads in Hepatitis
Glecaprevir/Pibrentasvir Efficacy & Safety Assessed, J Hepatol; ePub 2018 Nov 23; D’Ambrosio, et al
HCV Infection Among Children & Young Persons, J Hepatol; ePub 2018 Nov 26; Modin, et al
HCV Patients with Limited Access to Antiviral Therapy, Dig Liver Dis; ePub 2018 Nov 29; Lens, et al
Progression in the Elimination of HCV Infection, PLoS One; ePub 2018 Dec 4; Juanbeltz, et al
Increased HCV Screening in Veteran Populations, Jt Comm J Qual Patient Saf; ePub 2018 Sep 25; Wray, et al