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Understanding Cost and Value in Hepatitis C Therapy
1Boston University School of Medicine, Boston, MA, USA.
Insights
High costs limit access to new hepatitis C virus (HCV) treatments. Strategies like dedicated staff for prior authorizations and patient communication can improve access to essential HCV therapies.
Area of Science:
- Hepatology
- Infectious Diseases
- Health Economics
Background:
- Hepatitis C virus (HCV) infection treatment access is hindered by high therapy costs.
- Newer HCV regimens are cost-effective but face reimbursement challenges, particularly for early-stage disease, due to payer budget constraints in the US.
Purpose of the Study:
- To summarize strategies for maximizing patient access to appropriate hepatitis C virus (HCV) therapies.
- To address the economic barriers in accessing novel HCV treatments.
Main Methods:
- Summarizes a presentation on managing HCV in the era of new small molecule therapies.
- Focuses on practical approaches to overcome treatment access limitations.
- Highlights the importance of administrative support and patient engagement.
Main Results:
- Dedicated staff for prior authorizations and appeals are crucial for securing treatment approval.
- Documenting and sharing successful prior authorization strategies can improve collective success rates.
- Effective patient communication is vital to prevent patients from being lost to care.
Conclusions:
- Implementing dedicated administrative support and robust patient communication strategies can enhance access to cost-effective HCV treatments.
- Overcoming payer-related reimbursement hurdles is key to ensuring timely and appropriate HCV care.
- Proactive management of access barriers is essential for successful HCV treatment outcomes.
Abstract:
Access to newer therapies for the treatment of hepatitis C virus (HCV) infection is limited by the costs of these treatments. Newer HCV regimens have been shown to be cost-effective in early stages and late stages of the disease, but payers in the United States may refuse to reimburse for treatment of early disease because of budget constraints. Approaches that can maximize patients' access to appropriate therapy include having dedicated staff to handle prior authorizations and appeals, keeping records of successful approaches to prior authorizations and appeals and sharing these approaches with colleagues, and communicating with patients so that they will not be lost to appropriate health care. This article summarizes a presentation by Benjamin P. Linas, MD, MPH, at the IAS-USA continuing education program, Management of Hepatitis C Virus in the New Era: Small Molecules Bring Big Changes, held in Atlanta, Georgia, in September 2015.
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