Disparities in Absolute Denial of Modern Hepatitis C Therapy by Type of Insurance
Disparities in Absolute Denial of Modern Hepatitis C Therapy by Type of Insurance
复制标题
DOI：
10.1016/j.cgh.2016.03.040
复制
发表时间：
2016-07-01
影响因子：
12.6
通讯作者：
Kostman, Jay R.
中科院分区：
文献类型：
--
作者：
Lo Re, Vincent, III;Gowda, Charitha;Kostman, Jay R.
背景与目的：治疗慢性丙型肝炎病毒（HCV）感染的直接作用抗病毒（DAA）药物的高成本导致了治疗的拒绝，但目前尚不清楚患者获得这些治疗的机会是否与他们的保险类型不同。我们在2014年11月1日至4月30日期间提交DAA处方的所有患者中进行了一项前瞻性队列研究，2015年，Burman's Specialty Pharmacy为特拉华州、马里兰州、新泽西和宾夕法尼亚州的患者提供HCV药房服务。我们确定了绝对拒绝DAA处方的发生率，定义为根据保险类型（美国医疗补助，美国医疗保险或商业保险），保险公司未批准处方填写。多变量泊松回归估计调整后的相对风险绝对否认与患者的characteristics.Results：在2321例患者规定的DAA方案（503所涵盖的医疗补助，795所涵盖的医疗保险，1023所涵盖的商业保险），377（16.2%）收到了绝对否认。绝对拒绝的最常见原因是评估医疗需求的信息不足（134 [35.5%]）和缺乏医疗必要性（132 [35.0%]）。接受医疗补助的患者中有233人（46.3%）被拒绝，高于接受医疗保险（40人（5.0%）; P <0.001）或商业保险（104人（10.2%）; P <0.001）的患者。医疗补助保险（调整后的相对风险，4.14; 95%置信区间，3.38-5.08）和肝硬化（调整后的相对风险，1.96; 95%置信区间，1.53-2.50）的情况下与绝对denial.CONCLUSIONS：有显着的差异，在获得DAA为基础的治疗HCV感染的患者与不同类型的保险。特拉华州、马里兰州、新泽西和宾夕法尼亚州近一半的医疗补助受益人被拒绝获得这些治疗慢性丙型肝炎病毒感染的药物。
BACKGROUND & AIMS: The high costs of direct-acting antiviral (DAA) agents to treat chronic hepatitis C virus (HCV) infection have resulted in denials of treatment, but it is not clear whether patients' access to these therapies differs with their type of insurance.METHODS: We conducted a prospective cohort study among all patients who had a DAA prescription submitted between November 1, 2014 and April 30, 2015 to Burman's Specialty Pharmacy, which provides HCV pharmacy services to patients in Delaware, Maryland, New Jersey, and Pennsylvania. We determined the incidence of absolute denial of DAA prescription, defined as a lack of approval of a prescription fill by the insurer, according to type of insurance (US Medicaid, US Medicare, or commercial insurance). Multivariable Poisson regression was used to estimate adjusted relative risks of absolute denial associated with patient characteristics.RESULTS: Among 2321 patients prescribed a DAA regimen (503 covered by Medicaid, 795 covered by Medicare, and 1023 covered by commercial insurance), 377 (16.2%) received an absolute denial. The most common reasons for absolute denial were insufficient information to assess medical need (134 [35.5%]) and lack of medical necessity (132 [35.0%]). A higher proportion of patients covered byMedicaid received an absolute denial (233 [46.3%]) than those covered by Medicare (40 [5.0%]; P < .001) or commercial insurance (104 [10.2%]; P < .001). Medicaid insurance (adjusted relative risk, 4.14; 95% confidence interval, 3.38-5.08) and absence of cirrhosis (adjusted relative risk, 1.96; 95% confidence interval, 1.53-2.50) were associated with absolute denial.CONCLUSIONS: There are significant disparities in access to DAA-based treatments for HCV infection among patients with different types of insurance. Nearly half of Medicaid beneficiaries in Delaware, Maryland, New Jersey, and Pennsylvania were denied access to these drugs for chronic HCV infection.