Hepatitis Forums
Hepatitis C Main Forums => Hepatitis C Research News & Studies => Topic started by: Hep Editors on July 30, 2018, 10:19:50 am
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A considerable, and rising, proportion of people who apply to their insurance companies for coverage of hepatitis C virus (HCV) medications are flat-out denied.
Publishing their findings in Open Forum Infectious Diseases, researchers conducted a prospective cohort study among 9,025 people from 45 U.S. states who were prescribed a direct-acting antiviral (DAA) regimen for HCV and had a prescription submitted between January 2015 and April 2015 to Diplomat Pharmacy Inc. This company provides hep C pharmacy services across the nation.
Read more...
https://www.hepmag.com/article/one-three-people-seeking-insurance-coverage-hep-c-drugs-denied
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There seems to be an important discrepancy in the reports regarding the date range of prescriptions submitted and denied.
In the HEPCMAG article, https://www.hepmag.com/article/one-three-people-seeking-insurance-coverage-hep-c-drugs-denied , it says:
"Publishing their findings in Open Forum Infectious Diseases, researchers conducted a prospective cohort study among 9,025 people from 45 U.S. states who were prescribed a direct-acting antiviral (DAA) regimen for HCV and had a prescription submitted between January 2015 and April 2015 to Diplomat Pharmacy Inc. This company provides hep C pharmacy services across the nation."
However, in the quoted EurekaAlert press release, https://www.eurekalert.org/pub_releases/2018-06/idso-idf060518.php , it says:
"researchers used data from Diplomat Pharmacy Inc., which provides specialty pharmaceuticals, including direct-acting antiviral drugs for the treatment of hepatitis C, to patients in 45 U.S. states. Their analysis included 9,025 patients who had prescriptions for these drugs submitted to the pharmacy between January 2016 and April 2017."
Clearly, from what weve seen, denials were much higher when these drugs were first approved for use, and if January - April 2015 is the correct date of the prescription submissions, we would expect early denials to have been more prevalent than later as it would have represented the initial batch of Harvoni submissions. As we know it took a while for the insurance companies to come around.
But if the 2017 date range is correct, that obviously is much more concerning.
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Browsing through my research I found this
Absolute Insurer Denial of Direct-Acting Antiviral Therapy for Hepatitis C: A National Specialty Pharmacy Cohort Study
https://jumpshare.com/v/9XI7En9muDeRr5bk0KoS
For DAA prescriptions submitted to a national specialty pharmacy between January 2016 and April 2017, 35.5% were absolutely denied by the insurance carrier.
.....denial was higher among commercially insured (52.4%) and Medicaid (34.5%) beneficiaries compared with Medicare beneficiaries (14.7%). Notably, the incidence of denial increased for all insurance types over subsequent quarters during the observation period. Finally, the incidence of absolute DAA denial varied by type of insurance within and across states.
Contrary to our hypothesis, the overall incidence of absolute denial in this study (35.5%) was substantially higher in magnitude than that observed in 2 prior analyses conducted shortly after the release of all-oral DAA regimens (absolute denial range, 8.2%–16.2%) [17, 18].
In prior studies, denial of DAA therapy was reported to occur in as high as 46.3% of Medicaid beneficiaries [17, 18]. In contrast, the results of the present study indicate that the overall incidence of absolute denial of DAAs is now lower in magnitude for Medicaid beneficiaries (34.5%).
Throughout the observation period, the incidence of absolute denial was more common among patients covered by commercial insurance (52.4%) than by Medicaid (34.5%, P < .001) or Medicare (14.7%, P < .001).