The Prescribers’ Dilemma: Treatment of Hepatitis C Infection for Medicaid Insured Patients in United States

Abstract

Introduction of Direct Acting Antivirals (DAA) to Hepatitis C Virus (HCV) treatment 
armamentarium has offered a great boost to the providers’ confidence to safely and effectively 
treat HCV infection in the majority of patients. However, the cost of these medications is high 
and thus access is poor. Medicaid insurance providers have devised stringent eligibility criteria 
to approve the cost of DAA for its members. We reviewed the criteria among various Medicaid 
agencies from States of Ohio and Pennsylvania and noticed similarities and differences among 
them. The prerequisite process demanding clinical, laboratory, radiologic or histologic documentation is quite cumbersome and sometimes confusing. In certain aspects the eligibility requirements for DAA are not in concordance with the clinical evidence provided by the recently 
updated guidelines. We have addressed the dilemma most of the providers face while planning 
HCV treatment for the Medicaid insured patients in regards to the needed testing, clinical documentation and liver fibrosis assessment, along with the clinical implications of such requirements. While HCV remains a major public health issue, variable State Medicaid policies may 
lead to disparity in access to the emerging DAA with subsequent healthcare outcomes. These 
gaps may compromise long term efforts of the public health HCV initiatives.