Health inequities; hepatitis C; Medicaid; direct-acting antiviral


Health Policy | Infectious Disease | Primary Care


Background: Many people living with chronic Hepatitis C Virus (HCV) have seen delays in accessing treatment or been denied entirely due to Medicaid restrictions requiring patients to meet certain criteria prior to receiving approval for medication pre-authorization.

Methods: This study identified a cohort of Medicaid-insured patients with chronic HCV infection within New Orleans, LA. Patient medical records were reviewed and information regarding HCV care was gathered. This study sought to determine the degree to which HCV care was delayed for this population and describe common reasons for prior-authorization denials for direct-acting antiviral (DAA) medications.

Results: For this population of Medicaid-insured patients with HCV RNA assay-confirmed chronic infection, the average number of days it took to reach a specialist was three-times greater than the number of days it took to reach a primary care physician. After attending an appointment with a specialist to seek HCV care, patients experienced wait periods of an average of 150 days before being deemed eligible for treatment per Medicaid requirements. After being deemed eligible for treatment, patients experienced an average wait period of 194.4 days to initiation of treatment, with low fibrosis status being cited as the most common reason for treatment delay.

Conclusion: This population of Medicaid-insured patients in New Orleans, LA with chronic HCV infection experienced delays in treatment related to reduced accessibility of a specialist who was eligible to request DAA prior-authorization. Prior-authorization was most frequently denied based on low fibrosis status or recent alcohol/drug use.