Subscription-based payment models for hepatitis C treatment could improve access to expensive direct-acting antiviral therapy, published results show JAMA Health Forum.
Antiviral therapy can cure almost everyone with hepatitis C virus (HCV), but access to treatment is limited. Because these drugs are expensive, state Medicaid programs have put restrictions in place to limit who chooses to seek treatment. Sobriety and liver damage requirements can restrict access to people with substance use disorders and other sick people.
Payment-by-subscription (SBPM) models involving exclusivity contracts for drugs reduce high prices. States are able to negotiate lower prices with a drug manufacturer in exchange for the promise of exclusive treatment access for the state’s Medicaid population.
Louisiana and Washington both implemented dual-pricing payment models in 2019. Initially, both states pay a lower price until a specific price cap is reached; at this point, states pay a price per prescription that is minimized through additional deductions.
“With subscription payment models, there is no incentive to ration access because there is almost no cost of additional prescriptions beyond the threshold,” said Samantha Auty, Boston University School of Public. Health, in a Press release. “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. “
Auty and colleagues studied the impact of SBPMs on HCV prescription refills covered by Medicaid, examining trends in Louisiana and Washington, two states that have recently implemented such models.
For a period of five years, Louisiana has a pay program with Asegua Therapeutics for discounted access to the generic version of Epclusa from Gilead Science (sofosbuvir / velpatasvir), while Washington has access to Mavyret (glecaprevir / pibrentasvir) via AbbVie.
The researchers compared states that have implemented and have not implemented these payment models. They have used State Medicaid Drug Utilization Data on outpatient prescriptions for direct-acting antivirals between January 2017 and June 2020 for all 50 states and the District of Columbia. The main outcome was the number of prescriptions filled per 100,000 people enrolled in Medicaid.
Prior to the implementation of SBPMs in Louisiana and Washington, the average prescription refill rates per 100,000 Medicaid registrants were 43.1 and 50.1, respectively. After July 2019, the average rates increased to 206.0 and 53.9 prescriptions per 100,000 registrants, respectively.
There was a 534% relative increase in quarterly prescription renewals in Louisiana. However, the increase in prescription renewals in Washington was not significant. According to the researchers, these differences may be due to variations in program implementation or differences in HCV populations qualified for treatment coverage under state Medicaid rules as well as delays in testing. and treatment due to the COVID-19 pandemic.
Additionally, Louisiana’s restrictions on sobriety and liver damage were lifted along with the implementation of subscription-based payment, while Washington’s restrictions were lifted in 2016. Taking this into account in their analysis , the researchers found that Louisiana still saw a 180% increase in HCV prescriptions. after implementation.
“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. “I hope these results support the use of SBPM not only for HCV, but also for other high value drugs. “
Click here to read the study in the JAMA Health Forum.
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