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. 2021 Aug 27;2(8):e212285.
doi: 10.1001/jamahealthforum.2021.2285. eCollection 2021 Aug.

Association of Medicaid Managed Care Drug Carve Outs With Hepatitis C Virus Prescription Use

Samantha G Auty  1 , Paul R Shafer  1 , Stacie B Dusetzina  2 , Kevin N Griffith  2
Affiliations

Association of Medicaid Managed Care Drug Carve Outs With Hepatitis C Virus Prescription Use

Samantha G Auty et al. JAMA Health Forum. .

Abstract

Importance: Medicaid enrolls a disproportionate share of US adults with hepatitis C virus (HCV), and most receive Medicaid benefits through managed care organizations (MCOs). Medicaid MCOs often impose stricter requirements to access HCV medications than traditional fee-for-service Medicaid, which may inhibit use. Though Medicaid MCOs generally cover prescription drugs, several states have carved out direct-acting antiviral HCV medications from MCO coverage and opted to cover them under fee-for-service. Whether these carve outs were associated with changes in medication use is unknown.

Objective: To examine the association between Medicaid-covered HCV medication fills and carve outs of these medications from MCO coverage.

Design setting and participants: This cross-sectional study examined changes in fills of Medicaid-covered direct-acting antiviral HCV medications in 4 states (Indiana, Michigan, New Hampshire, and West Virginia) that carved out these drugs from Medicaid MCOs between 2015 and 2017. A synthetic control approach was used to compare changes in HCV prescription fills between states that did and did not carve out these medications from MCO prescription drug coverage. Data of direct-acting antiviral HCV prescription fills were obtained from the Medicaid State Drug Utilization Data files, January 2015 to June 2020. Data analysis was conducted from November 2020 to June 2021.

Exposures: Carve outs of direct-acting antiviral HCV medications from Medicaid MCO prescription drug coverage.

Main outcomes and measures: Direct-acting antiviral HCV prescriptions filled per 100 000 Medicaid enrollees.

Results: In this cross-sectional study, carve outs were associated with a mean quarterly increase of 22.1 (95% CI, 12.7-34.1) HCV prescriptions per 100 000 Medicaid enrollees, a relative increase of 86.3% compared with synthetic control states. Compared with each state's respective synthetic control, HCV prescription fills were associated with an increase of 11.5 (95% CI, 5.1-19.0) HCV prescription fills per 100 000 Medicaid enrollees per quarter in Indiana, 36.6 (95% CI, 23.5-53.9) in Michigan, 20.7 (95% CI, 11.1-32.8) in West Virginia, and 43.6 (95% CI, 25.9-68.4) in New Hampshire.

Conclusions and relevance: In this cross-sectional study of data from 39 states and the District of Columbia, carve outs of direct-acting antiviral HCV medications from Medicaid MCO prescription drug coverage were associated with significant increases in HCV medication use. Given their clinical benefits, greater uptake of HCV medication may help improve the health of Medicaid enrollees with HCV and reduce the economic burden of untreated HCV on the US health care system.

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Conflict of interest statement

Conflict of Interest Disclosures: Ms Auty is separately supported by the National Institute of Drug Abuse (T32-DA041898-03) and Dr Griffith is separately supported by the Agency for Healthcare Research and Quality (K12-HS026395). Dr Shafer reported receiving research support for unrelated work from the Robert Wood Johnson Foundation, the Commonwealth Fund, Renova Health, and the Department of Veterans Affairs (through a contract with the Boston University School of Public Health) and serving as a consultant to Patient Funding Alternatives for unrelated work. Dr Dusetzina reported grants from the Robert Wood Johnson Foundation, grants from The Leukemia & Lymphoma Society, grants from Arnold Ventures, personal fees from West Health, personal fees from the National Academy of State Health Policy, and personal fees from ICER outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Trends of Medicaid-Covered Hepatitis C Prescription Fills per 100 000 Medicaid Enrollees in Treated vs Synthetic Control States
The shaded area indicates the 2-year period after adoption of carve-out policies in each state. Weights used to construct the synthetic control states are presented in eTable 1 in the Supplement.
See this image and copyright information in PMC

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