UMass study examines barriers to hepatitis C treatment among MassHealth beneficiaries

August 18, 2016

Beyond high cost, people with hepatitis C face several barriers to treatment from various sources including doctors, Medicaid, private health insurance companies and intravenous drug use, according to a study, led by Karen Clements, assistant professor of quantitative health sciences at UMass Medical School and a senior project director in Commonwealth Medicine. Given that most Medicaid programs require prior authorization for new medicines, they sought to evaluate the percentage of MassHealth patients with hepatitis C who requested and received approval for treatment using sofosbuvir or simeprevir. The findings indicate that hepatitis C treatment referrals varied and that medication use did not increase as quickly as expected, even though MassHealth has few restrictions on treatment access. Antiviral treatment with the two drugs was requested for a relatively small proportion of the afflicted MassHealth members, and nearly all were approved. The review did not look at other states, but the authors believe that the percentage of eligible patients who are treated is similar or lower because many other states have stiffer requirements. The results suggest there could be a large group of untreated patients who could benefit from new treatment and may request it in the future, the authors stated. The study found that people with substance use disorders were less likely to have requested treatment than MassHealth members with advanced liver disease.