Medicaid Reimbursement for Oral Direct Antiviral Agents for the Treatment of Chronic Hepatitis C

Medicaid Reimbursement for Oral Direct Antiviral Agents for the Treatment of Chronic Hepatitis C
Kohtaro Ooka , MD 1 , James J. Connolly , MD 1 and Joseph K. Lim , MD 2

SUPPLEMENTARY MATERIAL is linked to the online version of the paper at http://www.nature.com/ajg

Am J Gastroenterol advance online publication, 4 April 2017; doi: 10.1038/ajg.2017.87

All-oral direct-acting antiviral (DAA) regimens are an excellent modality to treat chronic hepatitis C virus (HCV) infection. Federal Medicaid law requires states to cover all drugs from manufacturers with rebate agreements with the Department of Health and Human Services within their FDA label. However, because of their high cost, many state Medicaid agencies do not cover DAAs for those who have mild liver disease or who abuse substances (1 ,2) . These restrictions persist despite many analyses that confirm that DAA regimens are cost-effective (reduce the cost per quality adjusted life year) ( 3,4 ) and result in savings in healthcare spending ( 5 ). We sought to assess whether and how these restrictions have changed since oral DAAs fi rst came on the market. On the basis of our experience and anecdotal evidence, we expected that despite loosening of restrictions, the majority of states have restrictions in excess of those recommended by professional societies.

View Article
Download PDF

Full Text Articles
I highly suggest you follow Henry E. Chang on Twitter if you are interested in reading full text articles about the treatment and management of hepatitis C. The above link was tweeted on 4/4/17