Uptake of hepatitis C virus treatment in a multi‐state Medicaid population, 2013–2017. (4th May 2022) - Clements, Karen M.
Abstract: Objective: To examine trends in the direct acting antiviral (DAA) uptake in a multi‐state Medicaid population with hepatitis C virus (HCV) prior to and after ledipasvir/sofosbuvir (LDV/SOF) approval and changes in prior authorization (PA) requirements. Data Sources: Analyses utilized enrollment, medical, and pharmacy claims in four states, December 2013–December 2017. Study Design: An interrupted time series examined trends in uptake (1+ claim for a DAA) before and after two events: LDV/SOV approval (October 2014) and lifting of PA requirements for 40% of members (July 2016). Analyses were also performed in subgroups defined by the number and dates of change in PA requirements in members' Medicaid plans. Data Collection/Extraction Methods: Members aged 18–64 years with an ICD code for HCV were included in the sample from diagnosis date until treatment initiation or Medicaid disenrollment. Principal Findings: The annual sample size ranged from 38, 302 to 45, 005 with approximately 30% ages 18–34 years and 40% female. In December 2013, 0.08% was treated, rising to 0.74% in December 2017 ( p < 0.001). Uptake increased from 0.34%/month in October 2014 to 0.70%/month after LDV/SOF approval, ( p < 0.001), and increased relative to the pre‐LDV/SOV trend through June 2016 ( p = 0.04). Uptake increased to 1.18%/month after PA change, ( p < 0.001) and remained flat through 2017 ( p = 0.64). Cumulatively, 20.1% were treated by December 2017. In plans with few/no requirements through 2017, uptake increased to 1.19%/month after LDV/SOF approval ( p < 0.001) and remained flat through 2017 ( p = 0.11), with 22.2% cumulatively treated. Among plans that lifted PA requirements from three to zero in mid‐2016, uptake did not increase after LDV/SOF approval ( p = 0.36) but did increase to 1.41%/month ( p < 0.001) after PA change, with 18.1% cumulatively treated. Conclusions: HCV Treatment increased through 2017. LDV/SOF approval and lifting PA requirements led to an increase in uptake followed by flat monthly utilization. Cumulative uptake was higher in plans with few/no PA requirements relative to those with three requirements through mid‐2016.