New York State Medicaid recently removed prior authorization requirements for new patients, increasing opportunities for individuals to be treated and cured of hepatitis C.
Contact: Annette Gaudino, annette.gaudino@treatmentactiongroup.org
September 21, 2020 – The National Viral Hepatitis Roundtable (NVHR), the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI), and the Treatment Action Group (TAG) today applauded New York State (NYS) Medicaid for removing the requirement that new patients receive prior authorization approval for hepatitis C treatment. Additionally, NYS Medicaid will no longer impose sobriety screening requirements, which will help increase access to hepatitis C treatment for 223,700 individuals living with hepatitis C in New York.
“Removing prior authorization requirements is an important step in expanding access to hepatitis C treatment and we look forward to this policy being equally implemented across payors,” said NVHR Policy Manager Adrienne Simmons, PharmD. “By also eliminating the need for substance use screening, NYS Medicaid is removing discriminatory policies that propagated stigma and contradicted the standard of care.”
Prior authorization is a tool used by payors and insurance companies to determine if they will cover a prescribed procedure, treatment or medicine. In many cases, even if a clinician recommends a patient for hepatitis C treatment, Medicaid payors can deny coverage, which can lead to worse health outcomes for patients.
“Prior authorization requirements put payors in control of prescribing decisions, when clinical providers and patients should be making health care decisions together. Removing prior authorizations for first time treatment with direct acting antivirals for hepatitis C will shorten the time from diagnosis to cure and help New York State fulfill our commitment to ending the deadly hepatitis C epidemic,” said Annette Gaudino, Director of Policy Strategy at the Treatment Action Group.
However, current differences in coverage among fee-for-service and managed care organization programs continue creating barriers to universal access for hepatitis C treatment. With the new policy to remove prior authorization for preferred direct acting antivirals, NYS Medicaid payors have an opportunity to ensure coverage parity across programs.
“It is encouraging to see New York remove prior authorization requirements for first time hepatitis C treatment patients and help reduce further health complications and liver cancer,” said Robert Greenwald, Clinical Professor of Law at Harvard Law School and the director of CHLPI. “We encourage all payors and providers to immediately implement the new policies to help improve public health outcomes, especially during the coronavirus pandemic.”
For more information about NYS Medicaid hepatitis C treatment requirements, please visit https://stateofhepc.org/report/#NewYork.
About TAG
Treatment Action Group (TAG) is an independent, activist and community-based research and policy think tank fighting for better treatment, prevention, a vaccine, and a cure for HIV, tuberculosis, and hepatitis C virus. TAG works to ensure that all people with HIV, TB, and HCV receive lifesaving treatment, care, and information. We are science-based treatment activists working to expand and accelerate vital research and effective community engagement with research and policy institutions.
About the National Viral Hepatitis Roundtable (NVHR)
The National Viral Hepatitis Roundtable, a program of HEP, is a national coalition working together to eliminate viral hepatitis in the United States. NVHR’s vision is a healthier world without viral hepatitis. NVHR’s work is guided and informed by our beliefs and commitment to: Participation, Inclusiveness, Intersectionality, Health Equity, and Stigma Elimination. For more information, visit www.nvhr.org.
About the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI)
The Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) advocates for legal, regulatory, and policy reforms to improve the health of underserved populations, with a focus on the needs of low-income people living with chronic illnesses and disabilities. CHLPI works with consumers, advocates, community-based organizations, health and social services professionals, government officials, and others to expand access to high-quality health care; to reduce health disparities; to develop community advocacy capacity; and to promote more equitable and effective health care systems. CHLPI is a clinical teaching program of Harvard Law School and mentors students to become skilled, innovative, and thoughtful practitioners as well as leaders in health and public health law and policy. For more information, visit http://www.chlpi.org.
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