New Study: 1 in 4 Patients Initially Denied Hepatitis C Cures

by Amanda Conschafter, blog editor

Hepatitis C patients have a one in four chance of receiving curative treatment on their initial request, a new Yale University School of Medicine study reveals. Characterizing the denial rate as “surprising,” researchers noted that most patients do finally access the medications by appealing to insurers. But the pain of waiting can have real medical consequences.

While wading through the appeals process, some patients develop advanced liver disease or experience liver failure. Lead researcher Dr. Joseph Lim noted, “Restrictive policies may be viewed as short-sighted as some of the patients who are denied may develop liver cancer or liver failure requiring costly treatments, hospitalizations, or transplantation.”

READ: Improving Patient Access to Hepatitis C Cures

Researchers determined that patients who do have a higher likelihood of accessing the medications upon initial request are those with advanced liver disease. The discovery likely reflects private and government insurers’ policies, which often require proof of advanced liver fibrosis as part of a prior authorization process.

Regarding the trend of delaying access and rationing cures to only the sickest patients, Dr. Lim noted, “This is insurer-centered rather than a patient-centered approach.” He added that the researchers “hope these data may help inform national policy discussions on promoting more rational, patient-centered approaches to HCV treatment access.”

To explore access to new hepatitis C cures, researchers surveyed 129 patients between October and December 2014. The study appeared in PLOS ONE on August 27.


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