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- Title
Medicaid Expansion and Restriction Policies for Hepatitis C Treatment.
- Authors
Furukawa, Nathan W.; Ingber, Susan Z.; Symum, Hasan; Rapposelli, Karina K.; Teshale, Eyasu H.; Thompson, William W.; Zhu, Weiming; Roberts, Henry W.; Gupta, Neil
- Abstract
Key Points: Question: To what extent have Medicaid expansion status and prior authorization requirements limited access to hepatitis C direct-acting antivirals (DAAs) among Medicaid recipients? Findings: In this cross-sectional analysis of 381 373 Medicaid recipients who filled DAA prescriptions from 2014 to 2021, Medicaid nonexpansion status, fibrosis restrictions, and sobriety restrictions were all associated with a reduction in hepatitis C treatment rates among Medicaid recipients. Meaning: These findings suggest that removing prior authorization requirements will increase hepatitis C treatment rates. This cross-sectional study assesses the association of Medicaid expansion and restrictions on prescription of direct-acting antivirals with the rate of Medicaid recipients treated for hepatitis C nationwide. Importance: Hepatitis C can be cured with direct-acting antivirals (DAAs), but Medicaid programs have implemented fibrosis, sobriety, and prescriber restrictions to control costs. Although restrictions are easing, understanding their association with hepatitis C treatment rates is crucial to inform policies that increase access to lifesaving treatment. Objective: To estimate the association of jurisdictional (50 states and Washington, DC) DAA restrictions and Medicaid expansion with the number of Medicaid recipients with filled prescriptions for DAAs. Design, Setting, and Participants: This cross-sectional study used publicly available Medicaid documents and claims data from January 1, 2014, to December 31, 2021, to compare the number of unique Medicaid recipients treated with DAAs in each jurisdiction year with Medicaid expansion status and categories of fibrosis, sobriety, and prescriber restrictions. Medicaid recipients from all 50 states and Washington, DC, during the study period were included. Multilevel Poisson regression was used to estimate the association between Medicaid expansion and DAA restrictive policies on jurisdictional Medicaid DAA prescription fills. Data were analyzed initially from August 15 to November 15, 2023, and subsequently from April 15 to May 9, 2024. Exposures: Jurisdictional Medicaid expansion status and fibrosis, sobriety, and prescriber DAA restrictions. Main Outcomes and Measures: Number of people treated with DAAs per 100 000 Medicaid recipients per year. Results: A total of 381 373 Medicaid recipients filled DAA prescriptions during the study period (57.3% aged 45-64 years; 58.7% men; 15.2% non-Hispanic Black and 52.2% non-Hispanic White). Medicaid nonexpansion jurisdictions had fewer filled DAA prescriptions per 100 000 Medicaid recipients per year than expansion jurisdictions (38.6 vs 86.6; adjusted relative risk [ARR], 0.56 [95% CI, 0.52-0.61]). Jurisdictions with F3 to F4 (34.0 per 100 000 Medicaid recipients per year; ARR, 0.39 [95% CI, 0.37-0.66]) or F1 to F2 fibrosis restrictions (61.9 per 100 000 Medicaid recipients per year; ARR, 0.62 [95% CI, 0.59-0.66]) had lower treatment rates than jurisdictions without fibrosis restrictions (94.8 per 100 000 Medicaid recipients per year). Compared with no sobriety restrictions (113.5 per 100 000 Medicaid recipients per year), 6 to 12 months of sobriety (38.3 per 100 000 Medicaid recipients per year; ARR, 0.65 [95% CI, 0.61-0.71]) and screening and counseling requirements (84.7 per 100 000 Medicaid recipients per year; ARR, 0.87 [95% CI, 0.83-0.92]) were associated with reduced treatment rates, while 1 to 5 months of sobriety was not statistically significantly different. Compared with no prescriber restrictions (97.8 per 100 000 Medicaid recipients per year), specialist consult restrictions was associated with increased treatment (66.2 per 100 000 Medicaid recipients per year; ARR, 1.05 [95% CI, 1.00-1.10]), while specialist required restrictions were not statistically significant. Conclusions and Relevance: In this cross-sectional study, Medicaid nonexpansion status, fibrosis, and sobriety restrictions were associated with a reduction in the number of people with Medicaid who were treated for hepatitis C. Removing DAA restrictions might facilitate treatment of more people diagnosed with hepatitis C.
- Subjects
UNITED States; WASHINGTON (D.C.); MEDICAID law; HEALTH services accessibility; CROSS-sectional method; POISSON distribution; HEALTH insurance reimbursement; HEALTH policy; MULTIPLE regression analysis; RELATIVE medical risk; DESCRIPTIVE statistics; ANTIVIRAL agents; ELIGIBILITY (Social aspects); STATISTICS; HEPATITIS C; COMPARATIVE studies; CONFIDENCE intervals; DATA analysis software
- Publication
JAMA Network Open, 2024, Vol 7, Issue 7, pe2422406
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.22406