Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
Value Health. 2018 Jun;21(6):692-697. doi: 10.1016/j.jval.2017.09.011. Epub 2017 Nov 7.
New direct-acting antivirals (DAAs) can cure chronic hepatitis C virus (HCV) infection. High DAA prices combined with a large number of patients needing treatment may pose substantial economic burden on health systems.
To examine Medicaid reimbursement for medications for HCV infection before and after the availability of new DAAs overall and by state and to also assess the impact of Medicaid expansion on reimbursement for DAAs.
We calculated Medicaid reimbursements for medications for HCV infection between 2012 and 2015 in all 50 states and the District of Columbia. Outcomes included inflation-adjusted Medicaid reimbursement for medications for HCV infection, market share of individual DAAs, percentages of Medicaid outpatient pharmacy reimbursement for DAAs, and Medicaid reimbursement per Medicaid enrollee with HCV infection.
Medicaid reimbursement for medications for HCV infection increased from $723 million in 2012 to $2.35 billion in 2015. We found variations in Medicaid reimbursement for DAAs between states in 2014 (up to 7.4 times HCV infection prevalence) that widened in 2015 (0.1-11.4 times HCV infection prevalence). Expansion states had significantly higher increases in reimbursement for DAAs per enrollee with HCV infection compared with non- or late-expansion states ($2178.60; 95% confidence interval $1558.90-$2798.40), controlling for pre-expansion reimbursement.
Medicaid reimbursement for DAAs differs across states after controlling for HCV infection prevalence. A third of states contributed more than 5% to 15% of pharmacy reimbursements to DAAs. Medications for HCV infection are only one class of highly priced specialty drugs. Innovative policy strategies are needed for health systems to manage coverage for an increasing number of expensive specialty medications indicated for an increasing number of patients.
新的直接作用抗病毒药物（DAAs）可以治愈慢性丙型肝炎病毒（HCV）感染。高昂的 DAA 价格加上大量需要治疗的患者，可能会给卫生系统带来巨大的经济负担。
总体上以及按州评估新 DAA 上市前后医疗补助计划对 HCV 感染药物的报销情况，并评估医疗补助计划扩大对 DAA 报销的影响。
我们计算了 2012 年至 2015 年所有 50 个州和哥伦比亚特区的 HCV 感染药物的医疗补助报销情况。结果包括 HCV 感染药物的医疗补助报销额（经通胀调整）、个别 DAA 的市场份额、DAA 在 Medicaid 门诊药房报销中的百分比以及每例 HCV 感染 Medicaid 参保者的医疗补助报销额。
2012 年 HCV 感染药物的医疗补助报销额为 7.23 亿美元，2015 年增至 23.5 亿美元。我们发现，2014 年各州之间 DAA 的医疗补助报销存在差异（HCV 感染流行率最高相差 7.4 倍），2015 年这一差距进一步扩大（HCV 感染流行率最低相差 0.1 倍，最高相差 11.4 倍）。与非扩张或滞后扩张的州相比，扩张州每例 HCV 感染 Medicaid 参保者的 DAA 报销额增长显著更高（2178.60 美元；95%置信区间为 1558.90 美元至 2798.40 美元），同时控制了扩张前的报销额。
在控制 HCV 感染流行率后，各州之间 DAA 的医疗补助报销情况存在差异。三分之一的州对 DAA 药房报销的贡献超过 5%至 15%。HCV 感染药物只是高价专科药物的一个类别。医疗系统需要创新的政策策略来管理不断增加的昂贵专科药物的覆盖范围，以适应越来越多的患者。
