title: Accessibility to Oral Antiviral Therapy for Patients with Chronic Hepatitis C in the United States.
abstract: Background : Hepatitis C (HCV) direct acting antiviral agents (DAAs) are safe, effective, and tolerable. Most contraindications to interferon-based treatment are no long applicable. The aims of this study were to understand the predictors of approval to drug accessibility. Methods : We studied all consecutive patients with HCV prescribed DAAs between October 2014 and July 2015. Data on demographic, socio-economic status, comorbidities, baseline laboratory values, and assessment of liver disease severity, insurance, and specialty pharmacy type were collected. Multivariate analyses were performed to identify predictors of prescription approval. Results : In total, 410 patients were prescribed DAAs between October 2014 and July 2015. Of those, 332 (81%) patients were insurance approved for therapy. Of the 332 patients accepted, 251 were accepted after the first prescription attempt, and 38 were accepted after the second and third attempts. The number of attempts for the other 43 approved patients was unknown. Older age (p = 0.001), employment (p = 0.001), lack of comorbidities (p = 0.02), liver transplantation (p = 0.018), and advanced liver disease (p = 0.001) were more likely associated with obtaining approval. Household income was not associated with insurance approval. In the multivariate analysis, Medicare insurance (odds ratio [OR]) 2.67, 95% confidence interval [CI] 0.96-7.20), lack of nonliver comorbidities (OR 2.72, 95% CI 1.35-5.43), and the presence of advanced liver disease (OR 1.82, 95% CI 1.04-3.24) independently predicted drug approval. Conclusion : Despite the availability of DAAs for HCV, barriers from insurance carriers continue to impair widespread use. Patients with advanced liver disease, Medicare, and without comorbidities are most likely to be insurance approved for DAAs.
authors.affiliation: Department of Medicine, University of California, Los Angeles, CA, USA; Department of Surgery, University of California, Los Angeles, CA, USA.
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.affiliation: Department of Surgery, University of California, Los Angeles, CA, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Jimenez
authors.affiliation: Department of Surgery, University of California, Los Angeles, CA, USA.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Fong
authors.affiliation: Department of Surgery, University of California, Los Angeles, CA, USA.
authors.forename: Crystal
authors.initials: C
authors.lastname: Wu
authors.affiliation: Department of Surgery, University of California, Los Angeles, CA, USA.
authors.forename: Sherona
authors.initials: S
authors.lastname: Bau
authors.affiliation: Department of Surgery, University of California, Los Angeles, CA, USA.
authors.forename: Zoha
authors.initials: Z
authors.lastname: Jamal
authors.affiliation: Department of Surgery, University of California, Los Angeles, CA, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Grotts
authors.affiliation: Department of Surgery, University of California, Los Angeles, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Elashoff
keywords: Antiviral therapy; Healthcare access; Hepatitis C