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One-third of hepatitis C prescriptions rejected by insurers, study says

June 7 (UPI) — Public and private health insurers have denied more than one-third of claims for hepatitis C drugs that can cost several thousand dollars a month.

Researchers made the finding while analyzing data from Diplomat Pharmacy Inc., which provides specialty pharmaceuticals to patients in 45 U.S. states. Results of the analysis were published Thursday in the journal Open Forum Infectious Diseases.

“From a clinical standpoint, patients who are denied access to hepatitis C treatment are going to remain at risk for the development of liver complications like cirrhosis, hepatic decompensation and liver cancer,” Dr. Vincent Lo Re III, an associate professor of infectious disease and epidemiology in the Perelman School of Medicine at the University of Pennsylvania, said in a press release. “The denial of this treatment can also lead to ongoing hepatitis C-associated liver and systemic inflammation, which could increase the risk of other extra-hepatic complications, like cardiovascular disease, bone and joint disease, and kidney disease.”

Hepatitis C affects about 3.5 million people in the United States, according to the Centers for Disease Control and Prevention. In 2014, 19,659 people died — more than Americans than any other infectious disease, the CDC reported.

The direct-acting antiviral drugs, which went on the U.S. market in 2014, cure about 95 percent of people with chronic hepatitis C.

For a 12-week therapy, the brand name Harvoni costs $94,800 and Epclusa was priced at $75,000, according to Healthline. For an eight-week supply, Mavyret cost $26,400.

Researchers analyzed data for 9,025 patients with prescriptions submitted to the pharmacy between January 2016 and April 2017. The breakdown was 4,702 covered by Medicaid, 1,821 by Medicare and 2,502 by commercial insurance.

Of the patients, 35 percent were denied their prescribed treatment.

Commercial insurance had the highest denial rate at 52.4 percent, followed by 34.5 percent among Medicaid beneficiaries and 14.7 percent among Medicare patients.

In addition, denial rates increased from 27.7 percent in the first quarter of the study to 43.8 percent in the last quarter.

“Failure to treat and cure chronic hepatitis C infection also maintains a reservoir for transmission, which certainly can add to increasing incidence of the infection, especially given the growing opioid epidemic” Lo Re said. “If we want to achieve the goal of hepatitis C elimination, then access to hepatitis C therapy must be improved.”

Lo Re was a member of the National Academies of Sciences, Engineering and Medicine, which last year proposed eliminating hepatitis B and C infections as public health problems by 2030. The panel also called for eliminating access restrictions for direct-acting antiviral drugs for hepatitis C.

In 2015: the Centers for Medicare and Medicaid Services warned states that restricting access to the drugs based on cost could violate federal law.

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