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Abstract Details
Improving Access to High-Value, High-Cost Medicines: The Use of Subscription Models to Treat Hepatitis C using Direct Acting Antivirals in the United States
J Health Polit Policy Law. 2022 Jul 14;10041121. doi: 10.1215/03616878-10041121.Online ahead of print.
State payers may face financial incentives to restrict use of high-cost medications. Yet, restrictions on access to high-value medications may have deleterious effects on population health. Direct acting antivirals (DAAs), available since 2013, can cure chronic infection with Hepatitis C virus (HCV). With prices upwards of $90,000 for a treatment course, states struggled to ensure access to DAAs for Medicaid beneficiaries and the incarcerated, populations with a disproportionate share of HCV. Advance purchase commitments (APCs), wherein a payer commits to purchase a certain quantity of medications at lower prices, offer payers incentives to increase access to high-value medications and companies guaranteed revenue. Here, we discuss the use of subscription models, a type of APC, to support increased access to high-value DAAs to treat HCV. We start by providing some background information about HCV, its treatment, and state financing of prescription medications. We review the implementation of HCV subscription models in two states, Louisiana and Washington, and early evidence of their impact. We discuss challenges in evaluations of state-sponsored subscription models, and conclude with implications of subscription models targeting DAAs and other high-value, high-cost medicines.