Last data update: Sep 16, 2024. (Total: 47680 publications since 2009)
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Query Trace: Canary LA [original query] |
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Limited access to new hepatitis C virus treatment under state Medicaid programs
Canary LA , Klevens RM , Holmberg SD . Ann Intern Med 2015 163 (3) 226-8 The burden of fatal liver disease is increasing in the estimated 3.2 million adults chronically infected with hepatitis C virus (HCV) in the United States (1–3). Sofosbuvir (Sovaldi, Gilead Sciences), which was approved by the U.S. Food and Drug Administration in December 2013, is a new oral HCV treatment that, when combined with other therapies, has a therapeutic efficacy (cure) greater than 90% across the 4 major HCV genotypes, limited adverse effects, and a shorter treatment window (usually 12 weeks) than its interferon-based predecessors (4). However, this drug currently retails at $84 000 per patient, forcing many payers to ration this lifesaving treatment. As such, Medicaid programs, which cover approximately 25% of patients with HCV infection who are hospitalized but have limited budgets, face the challenge of deciding who should receive new, costly treatments (4, 5). | To understand policies that might affect patient access to new HCV therapies, we obtained preferred drug lists and prior authorization criteria from state Medicaid fee-for-service program Web sites and, when these were unavailable, elicited feedback from Medicaid programs through direct communication. We compared the guidelines used by state Medicaid programs with those published by the Infectious Diseases Society of America (IDSA) and the American Association for the Study of Liver Diseases (AASLD) (www.hcvguidelines.org). On the basis of data collected from May through November 2014, Medicaid programs in 31 states had designated sofosbuvir a "nonpreferred" drug, the prescription of which requires that clinicians provide evidence of medical necessity as defined by state-specific laws. Seventeen states applied a "preferred" designation, and although demonstrated medical necessity is not necessarily required in these states, all but 2 required clinicians to seek "prior authorization" for sofosbuvir prescription (Table ). |
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