State Medicaid Reimbursement for Medications for Chronic Hepatitis C Infection from 2012 through 2015

New direct-acting antivirals (DAAs) can cure chronic hepatitis C virus (HCV) infection. High DAA prices combined with a large number of patients needing treatment may pose substantial economic burden on health systems. To examine Medicaid reimbursement for medications for HCV infection before and af...

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Bibliographic Details
Published in:Value in health 2018-06, Vol.21 (6), p.692-697
Main Authors: Lu, Christine Y., Zhang, Fang, Golonski, Nicole, Lupton, Caitlin, Jeffrey, Paul, Wagner, Anita K.
Format: Article
Language:English
Subjects:
Ambulatory Care - economics
Ambulatory Care - statistics & numerical data
Antiviral agents
Antiviral Agents - economics
Antiviral Agents - therapeutic use
Antiviral drugs
Chronic infection
Confidence intervals
Cure
DAAs
direct-acting antivirals
Health care
Hepatitis
Hepatitis C
Hepatitis C, Chronic - economics
Hepatitis C, Chronic - therapy
Humans
Infections
Inflation
Insurance, Health, Reimbursement - economics
Insurance, Health, Reimbursement - statistics & numerical data
Market shares
Medicaid
Medicaid - economics
Medicaid - statistics & numerical data
Medicaid - trends
Patients
Pharmacy
Prices
Reimbursement
sofosbuvir
Sofosbuvir - economics
Sofosbuvir - therapeutic use
specialty drugs
Treatment needs
United States
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Summary:New direct-acting antivirals (DAAs) can cure chronic hepatitis C virus (HCV) infection. High DAA prices combined with a large number of patients needing treatment may pose substantial economic burden on health systems. To examine Medicaid reimbursement for medications for HCV infection before and after the availability of new DAAs overall and by state and to also assess the impact of Medicaid expansion on reimbursement for DAAs. We calculated Medicaid reimbursements for medications for HCV infection between 2012 and 2015 in all 50 states and the District of Columbia. Outcomes included inflation-adjusted Medicaid reimbursement for medications for HCV infection, market share of individual DAAs, percentages of Medicaid outpatient pharmacy reimbursement for DAAs, and Medicaid reimbursement per Medicaid enrollee with HCV infection. Medicaid reimbursement for medications for HCV infection increased from $723 million in 2012 to $2.35 billion in 2015. We found variations in Medicaid reimbursement for DAAs between states in 2014 (up to 7.4 times HCV infection prevalence) that widened in 2015 (0.1–11.4 times HCV infection prevalence). Expansion states had significantly higher increases in reimbursement for DAAs per enrollee with HCV infection compared with non- or late-expansion states ($2178.60; 95% confidence interval $1558.90–$2798.40), controlling for pre-expansion reimbursement. Medicaid reimbursement for DAAs differs across states after controlling for HCV infection prevalence. A third of states contributed more than 5% to 15% of pharmacy reimbursements to DAAs. Medications for HCV infection are only one class of highly priced specialty drugs. Innovative policy strategies are needed for health systems to manage coverage for an increasing number of expensive specialty medications indicated for an increasing number of patients.
ISSN:1098-3015
1524-4733
DOI:10.1016/j.jval.2017.09.011