Trends in Absolute DAA Regimen Insurance Denials in the United States

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Participants with commercial insurance were more likely to be denied DAAs compared with participants with Medicaid or Medicare.
Participants with commercial insurance were more likely to be denied DAAs compared with participants with Medicaid or Medicare.

Absolute denials of direct-acting antiviral (DAA) treatment regimens in patients infected with hepatitis C virus (HCV) have remained high and increased over time regardless of patient insurance type, according to results published in Open Forum Infectious Diseases.

The study included participants (n=9025) who had a DAA prescription submitted between January 2016 and April 2017 to Diplomat Pharmacy, Inc., a specialty pharmacy that provides HCV pharmacy services across the United States.

The main outcome was absolute denial of DAA prescription, which the researchers defined as a lack of fill approval by the insurer. The researchers calculated the overall incidence of absolute denial and the incidence by insurance type.

Of the 9025 participants with DAA prescriptions, 3200 were absolutely denied treatment. Participants with commercial insurance were more likely to be denied compared with participants with Medicaid or Medicare (52.4% vs 34.5% or 14.7%, respectively).

The researchers found that the incidence of absolute denial increased across each quarter of the study period, overall (27.7% in 1st quarter to 43.8% in last quarter; test for trend, P <.001) and for each insurance type (test for trend, P <.001 for each type).

“These data provide evidence of a continued lack of access to HCV therapy across insurance types,” the researchers wrote. “To achieve the goal of HCV elimination, access to antiviral treatment must be improved.”

Reference

Gowda C, Lott S, Grigorian M, et al. Absolute insurer denial of direct-acting antiviral therapy for hepatitis C: a national specialty pharmacy cohort study [published June 7, 2018]. Open Forum Infect Dis. doi:10.1093/ofid/ofy076

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