Hepatitis C Treatment Coverage Denials Increase Sharply

Recent data released by Trio Health show that the prevalence of hepatitis C drug patients diagnosed with Hepatitis C but not started on curative drugs, such as Harvoni (ledipasvir/sofosbuvir; Gilead) and Zepatier (elbasvir/grazoprevir; Merck), more than tripled between 2014 and 2016—signaling that payers continue to deny coverage despite increased marketplace competition and availability of discounts.

“There are no other disease states that I’m aware of where curative therapies are increasingly withheld from patients who are covered by commercial insurance plans, Medicaid or Medicare,” Nezam Afdhal, MD, professor of medicine, Harvard University, and chairman of Trio Health’s Scientific Steering Committee, said in a press release.

According to the data, although the number of treated patients continually decreases, the total number of patients seeking treatment for their condition continues to grow each year. On average, as of last September, 37% of patients who showed little-to-moderate traces of the disease were denied—a steady increase from 27% in October 2015. Likewise, 24% of those with advanced forms of hepatitis C were also denied—an increase from 15% during 2015. Overall, non-starts increased from 8% in 2014 to over 30% in 2016.

The data included evaluation of treatment patterns for use of all direct acting antiviral agents, including Harvoni, Sovaldi (sofosbuvir; Gilead), Epclusa (sofosbuvir/velpatasvir; Gilead), Viekira Pak (ombitasvir/paritaprevir/ritonavir/dasabuvir; Abbvie), Zepatier, and Daklinza (daclatasvir; Bristol-Myers Squibb).

“What is most surprising is that this trend is growing even though treatment cure rates are now above 90 percent, duration of therapy has been reduced to as little as eight weeks for the majority of patients, and real treatment costs are one-third lower than just a few years ago,” Dr Afdhal said. “In almost any other commercial setting, this would result in a significant expansion of market access, but with Hepatitis C, we’re seeing fewer patients receive care even though the number of patients seeking treatment continues to grow.”

It was reported that among commercial health plans 39% of patients with moderate disease activity did not start treatment after being prescribed therapy, and 36% of patients with severe disease activity also did not start.

According to the report, beneficiaries covered under Medicare and Medicaid each also experienced a delay in starting prescribed therapy. For patients with Medicaid coverage, 64% with moderate disease activity and 34% with severe disease activity did not start treatment after receiving their prescribed therapy in 2016. Additionally, among beneficiaries covered by Medicare, 17% with moderate disease activity and 13% with severe disease activity were non-starters.

Dr Afdhal stated that despite the drop in health care costs due to discounts provided by pharmaceutical companies, coverage denials continue to impede treatment startup.

—Julie Gould (Mazurkiewicz)