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Is Sicker Better?

With a cure for hepatitis C finally in reach, it’s disheartening to learn that one in four hepatitis C patients hear a “no” the first time they seek treatment. According to Yale researchers, one-quarter of patients with chronic infection of the hepatitis C virus (HCV) are denied their first pre-authorization request for Harvoni, one of the new and highly effective HCV medications. Sicker patients with advanced liver disease, according to this study published in the journal PLOS One, have a faster approval time.

This study looked at 174 patients prescribed any HCV treatment in a three-month period at the end of 2014. Most patients whose doctors prescribed Harvoni (77.5%) gained approval for treatment at their first request, while 13.9% of Harvoni-requesters were denied, but through an appeals process, later were granted this treatment.

These denials stem from insurers limiting the high-cost HCV treatment to patients with more progressed cases of this disease, in an effort to rein in costly treatments. Patients identified as having advanced fibrosis were more likely to receive approval without needing an appeals process. Yet, any delay can have a harmful impact on a patient’s long-term health.

Recent rebate programs are making headway in lowering the cost to payers of the new HCV treatments, in some cases by 40%. This should help relieve some of the payment pressures that contributed to these denials and delays, hopefully bringing patients more “yes” answers at the earliest request for HCV treatment.

Source: Is Sicker Better? | BioPlus Specialty Pharmacy

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