Kapadia Shashi N, Johnston Carrie D, Marks Kristen M, Schackman Bruce R, Martin Erika G
Division of Infectious Diseases (Drs Kapadia, Johnston, and Marks) and Department of Healthcare Policy and Research (Dr Schackman), Weill Cornell Medicine, New York, New York; and Department of Public Administration and Policy, University at Albany-SUNY, Albany, New York (Dr Martin).
J Public Health Manag Pract. 2019 May/Jun;25(3):245-252. doi: 10.1097/PHH.0000000000000829.
Curative treatments for hepatitis C virus (HCV) can alter the course of a devastating epidemic, but high drug prices have contributed to restrictions on HCV treatment access.
We aimed to learn how state health agencies have responded to the challenges of treatment access for HCV.
Qualitative study using semistructured key informant interviews focused on aspects of HCV treatment access between June 2016 and March 2017. Content analysis was used to identify dominant themes.
United States.
Eighteen health officials and treatment advocates across 6 states selected using purposive sampling.
Drug pricing is the most important barrier to access, encouraging restrictive authorization criteria from payers that in turn discourage providers from offering treatment. However, payers have not experienced the budget impact that was initially feared. Although authorization criteria are being lifted for fee-for-service Medicaid programs, ensuring that managed care organizations follow suit remains a challenge. The effect of stigma, a shortage of treating providers, and lack of political motivation are additional challenges to expanding treatment. The response to the human immunodeficiency virus epidemic can augment or inform strategies for HCV treatment delivery, but this is limited by the absence of dedicated funding.
While treatment eligibility criteria for HCV treatment are improving, many other barriers remain to achieving the scale-up needed to end the epidemic. Political disinterest, stigma, and a lack of specialty providers are continued barriers in some jurisdictions. States may need to invest in strategies to overcome these barriers, such as engaging in public and provider education and ensuring that treatment by primary care providers is reimbursed. Despite uncertainty about how federal policy changes to Medicaid may affect states' ability to respond, states can identify opportunities to improve access.
丙型肝炎病毒（HCV）的治愈性治疗可以改变这一毁灭性流行病的进程，但高昂的药品价格导致了HCV治疗可及性的限制。
我们旨在了解各州卫生机构如何应对HCV治疗可及性方面的挑战。
采用定性研究，于2016年6月至2017年3月期间，通过半结构化关键信息人访谈聚焦HCV治疗可及性的各个方面。采用内容分析法确定主要主题。
美国。
通过目的抽样从6个州选取了18名卫生官员和治疗倡导者。
药品定价是可及性的最重要障碍，促使支付方制定严格的授权标准，这反过来又使医疗服务提供者不愿提供治疗。然而，支付方并未经历最初担心的预算影响。尽管按服务收费的医疗补助计划的授权标准正在放宽，但确保管理式医疗组织效仿仍是一项挑战。耻辱感、治疗提供者短缺以及缺乏政治动力等因素是扩大治疗的额外挑战。对人类免疫缺陷病毒疫情的应对措施可以增强或为HCV治疗提供策略参考，但这受到缺乏专项资金的限制。
虽然HCV治疗的资格标准正在改善，但要实现扩大规模以终结这一流行病仍存在许多其他障碍。在一些司法管辖区，政治冷漠、耻辱感和专科医疗服务提供者短缺仍是持续存在的障碍。各州可能需要投资制定战略来克服这些障碍，例如开展公众和医疗服务提供者教育，并确保初级保健提供者的治疗能够得到报销。尽管联邦医疗补助政策变化对各州应对能力的影响尚不确定，但各州可以找到改善可及性的机会。
