• Login
    View Item 
    •   Home
    • UMass Chan Faculty and Staff Research and Publications
    • UMass Chan Faculty and Researcher Publications
    • View Item
    •   Home
    • UMass Chan Faculty and Staff Research and Publications
    • UMass Chan Faculty and Researcher Publications
    • View Item
    JavaScript is disabled for your browser. Some features of this site may not work without it.

    Browse

    All of eScholarship@UMassChanCommunitiesPublication DateAuthorsUMass Chan AffiliationsTitlesDocument TypesKeywordsThis CollectionPublication DateAuthorsUMass Chan AffiliationsTitlesDocument TypesKeywordsProfilesView

    My Account

    LoginRegister

    Help

    AboutSubmission GuidelinesData Deposit PolicySearchingUsage StatisticsAccessibilityTerms of UseWebsite Migration FAQ

    Statistics

    Most Popular ItemsStatistics by CountryMost Popular Authors

    Medicaid Policymaker Approaches to Prior Authorization Policies for Direct-Acting Antivirals for the Treatment of Hepatitis C Virus

    • CSV
    • RefMan
    • EndNote
    • BibTex
    • RefWorks
    Thumbnail
    Name:
    Medicaid Policymaker Approaches ...
    Size:
    353.3Kb
    Format:
    PDF
    Description:
    Poster
    Download
    Authors
    Greenwood, Bonnie C.
    Pratt, Carter
    Sefton, Laura
    Goldman, Roberta
    Gurewich, Deborah
    Clements, Karen M.
    Clark, Melissa
    UMass Chan Affiliations
    Commonwealth Medicine
    Document Type
    Poster
    Publication Date
    2022-06-05
    Keywords
    Medicaid
    Hepatitis C
    Direct-Acting Antivirals
    HCV
    Policies
    Treatment
    Prior Authorization
    
    Metadata
    Show full item record
    Abstract
    Research Objective: In response to the high cost of direct‐acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV), many Medicaid agencies implemented prior authorization (PA) policies designed to restrict access based on advanced liver disease, prescriber specialty, and/or substance use disorder history. Although PA policies have since been loosened, we have limited insight about the association between PA policies and DAA uptake, and factors impacting Medicaid agency policy decisions. In this mixed‐methods study evaluating the uptake of DAAs in four New England Medicaid programs, the objective of this analysis is to understand how and why the external context supports and impedes DAA uptake and the specific PA policies Medicaid agencies adopt. Study Design: Qualitative, recorded videoconference interviews were conducted between November 2020 and January 2021 using a semi‐structured interview guide. Key domains of inquiry included: 1) the PA policies adopted and why; 2) the systems and structures established to support these policies; and 3) factors that facilitate and impede policy implementation. Rapid qualitative analysis techniques were used to identify content and themes within the interviews. We compared results across states defined by relative uptake of DAAs (i.e., high versus low). DAA uptake was defined in the quantitative analysis as annually between 2014 and 2017. High uptake was defined as >10% uptake annually for all four years of the study. Population Studied: Interviews were conducted with the pharmacy director and other senior administrators responsible for setting medication PA policies from Medicaid agencies in four New England states. Two to three individuals were interviewed per state (N=11). Principal Findings: One state had high DAA uptake relative to the other three states. The interviews explored eight topic areas with only one emerging as varied between the high and low uptake states: the high uptake state did not have managed care organizations (MCOs); all low‐uptake states did. All states consulted with multiple internal stakeholders such as the Medicaid agency’s pharmacy team, drug utilization review board, medical director, and/or senior agency staff. All states consulted with multiple external stakeholders such as clinicians, academic institutions, departments of health, national and professional organizations, pharmacy benefit manager or fiscal agent, and/or MCOs. Supplemental rebates were leveraged by all states. Only one state implemented a specialized PA process for the DAAs. Conclusions: Overall, there were few differences in DAA PA policies and the development process between high and low‐uptake states but there were differences with respect to presence of MCOs. This suggests that variation in DAA uptake may be less driven by PA policies than by provider‐ and possibly patient‐level factors. Implications for Policy or Practice: To understand the variation in DAA uptake in Medicaid it is necessary to explore contextual factors beyond PA policy, such as provider‐ and possibly patient‐level factors. This research suggests there may be differences in how PA policies are mediated at the provider level. Understanding the broader context for medication uptake can allow Medicaid agencies to ensure they are achieving intended utilization patterns among their membership.
    DOI
    10.13028/ezpe-0q27
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/51480
    Notes
    Presented at AcademyHealth 2022 Annual Research Meeting.
    Funding and Acknowledgements
    AHRQ grant 5R01HS025717-02
    Rights
    Copyright © 2022 The Author(s)
    ae974a485f413a2113503eed53cd6c53
    10.13028/ezpe-0q27
    Scopus Count
    Collections
    UMass Chan Faculty and Researcher Publications
    ForHealth Consulting Publications

    entitlement

     
    DSpace software (copyright © 2002 - 2023)  DuraSpace
    Lamar Soutter Library, UMass Chan Medical School | 55 Lake Avenue North | Worcester, MA 01655 USA
    Quick Guide | escholarship@umassmed.edu
    Works found in eScholarship@UMassChan are protected by copyright unless otherwise indicated.
    Open Repository is a service operated by 
    Atmire NV
     

    Export search results

    The export option will allow you to export the current search results of the entered query to a file. Different formats are available for download. To export the items, click on the button corresponding with the preferred download format.

    By default, clicking on the export buttons will result in a download of the allowed maximum amount of items.

    To select a subset of the search results, click "Selective Export" button and make a selection of the items you want to export. The amount of items that can be exported at once is similarly restricted as the full export.

    After making a selection, click one of the export format buttons. The amount of items that will be exported is indicated in the bubble next to export format.