title: Disparate access to treatment regimens in chronic hepatitis C patients: data from the TRIO network.
abstract: Despite the clinical success in the real-world of all oral hepatitis C virus (HCV) therapy with response rates approaching that seen in the clinical trials, access has been limited by many payers with discussion of prioritization of treatment based upon AASLD guidelines. We evaluated patients in the TRIO network who were prescribed sofosbuvir (SOF)-based regimens to determine reasons for not starting treatment. Trio Health is a disease management company that works in partnership with academic medical centres, community physicians and specialty pharmacies in the United States to optimize care for HCV. Data for 3841 patients prescribed a sofosbuvir-containing regimen between December 2013 and September 2014 were obtained through this programme. Of the entire group, 315 (8%) patients did not start the prescribed sofosbuvir-containing therapy. A total of 141 (45%) of the nonstart patients had a commercial plan as their primary insurance, 137 (44%) were primarily covered by Medicaid, 17 (5%) were primarily covered by Medicare, and 20 (6%) were either without coverage or coverage was not specified. Reasons for nonstarts were varied and overlapping. Only 15 patients (5% of nonstarts) did not start because they were unreachable or failed to complete required testing. Another 39 patients who did not start (12%) were following their physicians' direction to either wait for new treatment options or to hold treatment for an unspecified reason. Insurance-related processes and financial reasons accounted for 254 (81%) of the 315 nonstarts. The remaining 7 (2%) patients did not have a specified reason for not starting treatment. Nonstart rates were highest in the Medicaid-covered population at 35%. Medicare and Commercial nonstart rates were 2% and 6%, respectively. In a matched comparison, patients with commercial coverage were 6.5 times as likely to start SOF-based therapy compared to patients with Medicaid. Despite high SVR rates of SOF-based regimens in clinical practice, there are still barriers to access to care. In fact, almost half of the nonstart patients had advanced fibrosis scores (F3 or F4) and should have been prioritized to start treatment. As better treatment for HCV with high efficacy and low side effect rates become available, the disparity in access to treatment, as evidenced by the high nonstart rate in the Medicaid-covered group, must be resolved.
authors: Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.
authors: Z M
authors: ZM
authors: Younossi
authors: Division of GI and Hepatology, Saint Louis University School of Medicine, St. Louis, MO, USA.
authors: B R
authors: BR
authors: Bacon
authors: Icahn School of Medicine, Mount Sinai, New York, NY, USA.
authors: D T
authors: DT
authors: Dieterich
authors: Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors: S L
authors: SL
authors: Flamm
authors: Liver Care Network, Swedish Medical Center, Seattle, WA, USA.
authors: K
authors: K
authors: Kowdley
authors: Trio Health Analytics, La Jolla, CA, USA.
authors: S
authors: S
authors: Milligan
authors: Queens Medical Center, University of Hawaii, Honolulu, HI, USA.
authors: N
authors: N
authors: Tsai
authors: Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors: A
authors: A
authors: Nezam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000008:administration & dosage*; D005260:Female; D006297:Health Services Accessibility; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000069474:Sofosbuvir / Q000008:administration & dosage*; D014481:United States; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D000069474:Sofosbuvir
keywords: hepatitis C virus; insurance; medicaid; medicare