Posted: October 21, 2014 - 4:15 pm ET
Which Medicaid beneficiaries will have access to Gilead Sciences' newest high-cost hepatitis C treatment, Harvoni, and when they'll get that access, now depends on prior-authorization criteria being hammered out by various state agencies.
Most will likely limit Harvoni use to patients dealing with liver failure, as 35 states now do for Gilead's Sovaldi. Some may adopt restrictions such as banning those dealing with drug and alcohol addiction from getting the specialty drug, or limiting who may prescribe it to only board-certified gastroenterologists, hepatologists or infectious disease physicians. Another option is implementing the so-called “once in a lifetime” rule, which allows Medicaid patients only one chance at treatment.Continue reading...
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