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Abstract Details
Medicaid Hepatitis C Virus Treatment Policies: Impact on Testing and Treatment in the Commercially Insured
Am J Prev Med. 2022 Jun 17;S0749-3797(22)00161-1. doi: 10.1016/j.amepre.2022.03.010.Online ahead of print.
1Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Section of Infectious Diseases, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts. Electronic address: rachel.epstein@bmc.org.
2Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts.
3Division of Infectious Diseases, Joan and Sanford I. Weil Department of Medicine, Weill Cornell Medicine, New York, New York.
4Department of Health Law, Policy, & Management, Boston University School of Public Health, Boston, Massachusetts.
5Department of Population Health Sciences, Weill Cornell Medicine, New York, New York.
6Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.
Abstract
Introduction: A total of 23 state Medicaid programs continue to restrict hepatitis C virus (HCV) medication access by liver disease or substance-use criteria, creating obstacles to HCV elimination and significant care disparities. Because public insurers often set precedents for private insurer coverage and clinician practice patterns, this study sought to analyze whether spillover occurs from state Medicaid HCV treatment restrictions to HCV screening and treatment rates in commercially insured individuals.
Methods: Investigators analyzed 2014?2017 commercial claims data across 48 U.S. states (721,961,965 person-months) and used an interrupted times series design to compare hepatitis C virus screening and treatment rates before and after state Medicaid HCV treatment policy changes, adjusting for state-level random effects, Medicaid expansion status, and state drug overdose incidence rates, in states that relaxed Medicaid policy over the study period. Analysis occurred during 2019?2021.
Results: Hepatitis C virus screening rates among commercially insured individuals increased after the corresponding state Medicaid program relaxed HCV treatment policy. Among states that changed Medicaid policy, those that reduced fibrosis or both fibrosis and abstinence restrictions experienced increased HCV screening rates by the study end compared with states that changed only abstinence restrictions (rate ratio=1.29; 95% CI=1.15, 1.44; and rate ratio=1.32; 95% CI=1.17, 1.50, respectively). Similar patterns did not occur in HCV treatment rates, which declined after 2015 across groups.
Conclusions: These data show that HCV screening rates increased among commercially insured individuals after the removal of Medicaid HCV treatment restrictions in the same state. This suggests that Medicaid treatment policies can spill over to affect health outcomes among commercially insured populations.