Medicaid Subscription-Based Payment Models and Implications for Access to Hepatitis C Medications

Area of Science:

• Hepatology
• Health Economics
• Public Health Policy

Background:

• Hepatitis C virus (HCV) is curable with direct-acting antivirals, but high costs limit access through state Medicaid programs.
• Subscription-based payment models (SBPMs) offer a potential solution by contracting with manufacturers for reduced medication prices.
• The impact of SBPMs on HCV medication utilization within Medicaid populations remains unclear.

Purpose of the Study:

• To evaluate the association between SBPM implementation and changes in Hepatitis C virus (HCV) medication prescription fills.
• To compare HCV medication use trends in states before and after SBPM adoption using a synthetic control approach.

Main Methods:

• Cross-sectional analysis of Medicaid State Drug Utilization Data from January 1, 2017, to June 30, 2020.
• Utilized a synthetic control method to compare prescription fill rates in Louisiana and Washington with control states.
• Measured outcomes as quarterly prescription fills per 100,000 Medicaid enrollees.

Main Results:

• Louisiana saw a significant increase in HCV medication fills (173.5 per 100,000 enrollees, a 534.5% relative increase) after SBPM implementation.
• Washington did not show a significant change in HCV prescription fills following SBPM adoption.
• Pre-implementation fill rates were comparable between Louisiana and Washington.

Conclusions:

• SBPM implementation was associated with a substantial rise in Hepatitis C virus (HCV) medication use in Louisiana's Medicaid population.
• Washington experienced no significant change in HCV medication fills post-SBPM implementation.
• Variations in SBPM implementation and external factors may explain differing outcomes between the states.