The development of direct-acting antiviral agents (DAAs) revolutionized the treatment of hepatitis C virus (HCV) in 2013, transforming the disease from a controllable disease to a curable one. But with a list price of $ 25,000 to $ 95,000 per prescription, state Medicaid programs, which insure a disproportionate number of people with HCV, have placed strict limits on who can qualify for these drugs.
Subscription payment models (SBPM), a new approach in which states contract exclusively with a single manufacturer to deliver prescriptions at a discounted price, could increase access to these life-saving treatments, according to a new study from the School public health. In an SBPM, states pay reduced prices per prescription for drugs up to a certain threshold of use. Beyond this threshold, the cost of additional prescriptions is practically zero.
Published in the journal JAMA Health Forum, the study looked at changes in Medicaid-covered HCV prescription fills in Louisiana and Washington after both states implemented SBPMs in July 2019. Although Washington did not experience any significant change in quarterly HCV prescription fills, Louisiana’s prescription fills increased 534%.
“With subscription payment models, there is no incentive to ration access because there is almost no cost of additional prescriptions beyond the threshold,” says lead author of the study, Samantha. Auty, doctoral student in the Department of Health Law, Policy and Management. “This model actually encourages states to treat as many people who would benefit from HCV treatment as possible, which improves the health of the population in a group of people who face structural barriers to care and aligns with WHO’s goals to eradicate this virus by 2030. “
For the study, Auty and colleagues used publicly available Medicaid data from the 50 states and Washington, DC to compare changes in HCV prescription fillings between the two states that implemented SBPMs and those who haven’t. The average HCV prescription rate per 100,000 Medicaid registrants fell from 43.1 to 206.0 in Louisiana and from 50.1 to 53.9 in Washington.
The researchers say that the differences in increased drug use between the two states may be explained by state variation in SBPM implementation, differences in populations qualified for HCV drug coverage prior to treatment. SBPM in every state, and delays in screening and treatment due to the Covid19 pandemic. Louisiana lifted its restrictions on liver damage and sobriety for access to HCV drugs concurrently with the passage of the SBPM, while Washington removed these restrictions in 2016. Even with this change in mind, the Louisiana saw a 180.2% increase in HCV prescription use after the passage of SBPM.
The SBPMs are similar to the pre-market engagement the United States has adopted for its COVID vaccination strategy, in which the country has committed to purchasing expensive vaccines from selected manufacturers, Auty said. The SBPM model appears to be a scalable solution that other states could apply to multiple public health issues, she says.
“Our results prove that SBPMs can work, and there are other outbreaks in the United States that could benefit from this type of model,” Auty said. “Medicines for opioid use disorders save many lives by reducing the risk of overdose, death and other co-morbidities associated with use. My hope is that these results support the use of SBPM not only for HCV, but also for other high value drugs.
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Samantha G. Auty et al, Medicaid Subscription Payment Models and Implications for Access to Hepatitis C Medicines, JAMA Health Forum (2021). DOI: 10.1001 / jamahealthforum.2021.2291
Subscription payment models could improve access to hepatitis C drugs (2021, September 6)
retrieved September 6, 2021
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