Three state Medicaid programs have eliminated prior authorizations for hepatitis C treatment for most patients, joining a growing number of states to increase access to treatment for Medicaid recipients.
The Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) and the National Viral Hepatitis Roundtable (NVHR) today recognize the Idaho, Massachusetts and New Hampshire state Medicaid programs for removing prior authorizations for hepatitis C treatment for most patients, becoming the twelfth, thirteenth and fourteenth states in the country, respectively, to increase access for most Medicaid recipients by removing prior authorizations.
Idaho Medicaid removed prior authorizations for preferred agents, while Massachusetts Medicaid (MassHealth) and New Hampshire Medicaid removed prior authorizations for patients who qualify for simplified treatment. The lifting of this administrative burden imposed on healthcare providers will streamline access to curative direct-acting antivirals (DAAs). While this policy change has been implemented for fee-for-service beneficiaries, some managed care organizations (MCOs) in Massachusetts and New Hampshire are not yet in compliance with this new policy.
Cases of hepatitis C, a viral infection that causes liver inflammation and is one of the leading causes of liver disease, have been increasing since 2010 due to the ongoing opioid crisis. National trends indicate a rise in hepatitis C case incidence in tandem with a decrease in hepatitis C treatment rates over the past several years. Complications from hepatitis C can be fatal if left untreated. However, DAAs can cure most people in 8 to 12 weeks. Yet barriers to this treatment including prior authorization requirements persist across the country.
“It is encouraging to see Idaho, Massachusetts and New Hampshire following the lead of other states across the country to remove burdensome prior authorization requirements on hepatitis C treatments for Medicaid recipients. More state Medicaid programs across the country are understanding that ensuring access to curative treatments for historically marginalized populations is imperative to adequately addressing the hepatitis C epidemic,” said Robert Greenwald, Faculty Director for the Center for Health Law and Policy Innovation.
“As hepatitis C cases continue to rise, it’s critical that state Medicaid programs ensure that MCOs uniformly and expeditiously implement the same policy changes that are made for fee-for-service beneficiaries in order to increase access to life-saving treatment,” said Adrienne Simmons, Director of Programs at NVHR. “We urge Idaho, Massachusetts and New Hampshire to ensure that beneficiaries and their providers are made aware of these changes in order to ensure the broadest possible access to hepatitis C treatment. In addition to increasing access to treatment for hepatitis C, states must use effective and equitable harm reduction, screening, and linkage to care strategies that prioritize the people who need care most.”