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Nearly Half of Medicaid Patients with Hepatitis C were denied Coverage to Drugs

Update Date: Nov 17, 2015 09:44 AM EST
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Not all hepatitis C patients with Medicaid are able to access potentially life-saving drugs, new research found.

According to a new study, nearly 50 percent of these patients could not get coverage to certain anti-viral medications because these newer drugs were not considered to be "a medical necessity." The team also found other factors that affected whether or not a patient on Medicaid would be covered.

For this study, the researchers examined prescription data on 2,342 hepatitis C patients between November 2014 and April 2015. The insurance breakdown was: 517 on Medicaid, 800 on Medicare and 1,025 on private insurance. The data had been submitted to the Burman's Specialty Pharmacy branches in Delaware, Maryland, New Jersey and Pennsylvania.

The researchers found that overall, 16 percent or 377 patients were denied access to these drugs. The group with the highest rate of absolute denial was the Medicaid group at 46 percent. The denial rates for the Medicare and private insurance groups were five percent and 10 percent, respectively.

The top two reasons why Medicaid denied coverage were "insufficient information to assess medical need" at 48 percent and "lack of medical necessity" at 31 percent. A third reason - at four percent - was that the patient tested positive on an alcohol or drug screen.

"It's the high costs of these agents to treat-and in most cases, cure-these infections and barriers to coverage that have resulted in denials and delays for the therapies," Vincent Lo Re III, MD, MSCE, an assistant professor of Medicine and Epidemiology in the division of Infectious Diseases at the Perelman School of Medicine at the University of Pennsylvania and the Center for Clinical Biostatistics and Epidemiology, said reported by MedicalXpress. "It has created a serious health disparity. Patients on Medicaid are more likely to be suffering from these infections, yet they are much more likely to be denied coverage for the drugs."

The researchers also found that even when Medicaid patients received coverage, they had to wait longer than patients on Medicare or private insurance before getting the drugs.

The team concluded that Medicaid should focus on increasing access to these drugs for patients who need them.

The findings will be presented at the American Association for the Study of Liver Diseases (AASLD) 2015 Liver Meeting.

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