Virginia Medicaid Hepatitis C Therapy Patient Treatment Agreement

Although the restriction of access to sofosbuvir among Medicaid recipients has been associated with prolonged substance use and reduced spending, these criteria raise significant concerns regarding medical ethics, clinical evidence and possibly federal law. Providing HCV treatment to clinically eligible Medicaid recipients is an important public health measure, and policy makers should oppose these requirements under The Medicaid coverage policy and adopt strategies to reconcile short-term budget realities with long-term treatment benefits. Our result was the share of Medicaid`s costs for prescription drug expenses of sofosbuvir. We used data from previous analyses16,17 to identify the criteria used in the Medicaid pre-authorization guidelines for service until the end of 2014, with each criterion classified as clinical, administrative or behavioral (Table 1). We also divided the behavioural criteria into two sub-domains: treatment criteria (which patients must treat for substance or alcohol abuse) and abstinence criteria (which require patients abstinent of alcohol or illicit substances). Although there may be several characteristics of abstinence, including the achievement of abstinence and the presence or length of abstinence waiting time, these were considered together for the purposes of defining criteria. The relationship between expenditure and behaviour criteria was not influenced by the adaptation of the three types of criteria and government decisions regarding the expansion of Medicaid (Table 3). In multivariate analyses, the existence of strict behavioural criteria was associated with a 1.44% decrease in the share of Medicaid`s total pharmaceutical expenditure in sofosbuvir (P -007). In analyses that divided the behavioural criteria into treatment and abstinence components, We found that the presence of strict abstinence criteria – that is, the periods of abstinence required for all patients prior to sofosbuvir treatment – was associated with a decrease in the share of Medicaid`s total expenditure in sofosbuvir (P-045), while there was no significant link between rigorous treatment criteria and expenditures (P-.16). In multivariate analyses, we found no significant association between sofosbuvir expenditures and the existence of strict clinical or administrative criteria. Sensitivity analyses confirmed these results: the existence of strict behavioural criteria, but not strict clinical or administrative criteria, was significantly related to expenditure. In particular, people who inject drugs have shown compliance and therapeutic response to traditional interferon-based therapies, 22 Since injection drug use is also the most common risk factor for HCV infection,23 Efforts to eradicate existing HCV infections and prevent future spread, specific treatment should be provided for those injecting drugs.24 .25 , fewer toxic agents such as sofosbuvir or other direct-acting antivirals are likely to meet public health priorities and clinically and inexpensively.26 At the price of $1,000 per pill, sofosbuvir is fundamentally prohibitive for government programs.

Cost control strategies used in private markets, for example. B, cost-sharing through co-insurance, are unsustainable in low-income Medicaid populations. The status quo of price negotiations and rebate agreements between individual states and drug manufacturers may moderate the budgetary impact of sofosbuvir, but it is not sufficient to create an overall parity of access for beneficiaries with clinical claims.