A Modifiable Barrier to Hepatitis C Virus Elimination in Rhode Island: The Prior Authorization Process for...

Area of Science:

• Hepatology
• Public Health
• Health Policy

Background:

• Hepatitis C virus (HCV) disproportionately affects marginalized populations in Rhode Island (RI).
• Direct-acting antiviral (DAA) agents offer a safe and curative treatment for HCV.
• Access to DAAs in RI is restricted by payer-imposed prior authorization (PA) requirements.

Purpose of the Study:

• To assess the specific prior authorization (PA) criteria for direct-acting antiviral (DAA) medications in Rhode Island.
• To analyze the differences in PA forms, approval, and appeal processes among RI payers.

Main Methods:

• Review of payer websites and direct contact with payers to obtain DAA PA forms.
• Description and analysis of DAA PA requirements, including data elements and approval processes.
• Evaluation of post-approval barriers such as time limitations and restricted pharmacy networks.

Main Results:

• Substantial variations exist among RI payers' DAA PA requirements.
• All PA forms necessitate clinically superfluous data, including post-treatment results and co-treatment documentation.
• The PA process is time-consuming (45-120 minutes per patient) and includes post-approval access barriers.

Conclusions:

• Current DAA PA criteria in RI are complex, inconsistent, and create significant barriers to HCV treatment.
• Standardization, streamlining, and eventual removal of DAA PA requirements are crucial for HCV elimination.
• Policy changes are needed to improve patient access to life-saving HCV therapies.