College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
J Pharm Pharm Sci. 2018;21(1s):271s-308s. doi: 10.18433/jpps30220.
Direct-acting antivirals (DAAs) have become the standard treatment for patients with chronic hepatitis C infections because of their high cure rates and favourable side effect profiles; however, access to this new class of agents has been limited because of its high cost. Public payers across Canada have implemented strict criteria for drug coverage in order to contain expenditures. Efforts have been made to improve access to medication for this high-burden condition. Recent coverage criteria across national and international jurisdictions have been compared.
Coverage criteria for several DAAs were reviewed by accessing Canadian provincial drug formularies. International coverage (e.g., Europe, Australia, United States, Egypt, India) was reviewed by searching available literature.
Coverage criteria vary across Canada. By April 2018, most Canadian jurisdictions had removed the stage 2 liver fibrosis requirement for patients to be eligible for coverage. Internationally, patients' access to DAAs differs significantly. Many jurisdictions restrict DAA prescribing authority to specialists and request documentation of chronic hepatitis C. In the US, considerable gaps of coverage are identifiable and patients might face significant financial burden to receive treatment.
DAAs appear to be generally accessible through public drug plans in Canada compared to other countries.
直接作用抗病毒药物（DAAs）因其高治愈率和良好的副作用而成为慢性丙型肝炎感染患者的标准治疗方法；然而，由于其成本高昂，这种新类别的药物的获得受到限制。为了控制支出，加拿大各地的公共支付方都对药物覆盖制定了严格的标准。已经为改善这种高负担疾病的药物获得做出了努力。最近比较了国家和国际司法管辖区的覆盖标准。
通过访问加拿大省级药品处方集，审查了几种 DAA 的覆盖标准。通过搜索现有文献，审查了国际覆盖范围（例如欧洲、澳大利亚、美国、埃及、印度）。
加拿大各地的覆盖标准各不相同。到 2018 年 4 月，加拿大大多数司法管辖区已取消了 2 期肝纤维化阶段的要求，以使患者有资格获得覆盖。在国际上，患者获得 DAA 的机会差异很大。许多司法管辖区将 DAA 处方权限制给专家，并要求提供慢性丙型肝炎的文件。在美国，可以发现相当大的覆盖差距，患者可能面临接受治疗的巨大经济负担。
与其他国家相比，DAA 似乎在加拿大通过公共药品计划普遍获得。
