Restrictions of Hepatitis C Treatment for Substance-Using Medicaid Patients
Cost Versus Ethics
Bibliographic Data
Medicaid programs provide health insurance coverage for many patients with hepatitis C, a public health problem for which effective but very expensive treatments are now available. Facing constrained budgets, most states adopted prior authorization criteria for sofosbuvir, the first of these agents. Using fee-for-service utilization data from 42 Medicaid programs in 2014, we found that strict behavioral criteria—those that limited coverage on the basis of drug or alcohol use and included specific abstinence or treatment requirements—were associated with significantly less spending on sofosbuvir. Despite the potential cost savings, such criteria raise troubling questions in terms of public health as well as medical ethics, clinical evidence, and potentially federal law. Decision-makers should reject these requirements in Medicaid coverage policy and pursue national and state policy strategies to balance short-term budgetary realities with long-term public health benefits
Abstinence · Actuarial science · Business · Economics · Environmental health · Health care · Medicaid · Political science · Prior authorization · Psychiatry · Public economics · Public health · Healthcare Policy and Management · Hepatitis C virus research · Law · Medicine · Nursing · Primary Care and Health Outcomes · Health Policy
| Citations per year | 0.5 |
|---|---|
| Citation span | 2022 - 2024 (3) |
| Highly cited | No |