Texas Medicaid patients with hepatitis C have struggled for years to access potentially curative antiviral medications. But this will get much easier on Sept. 1.
Starting next month, Texas Medicaid will designate a preferred direct acting antiviral (DAA) drug option for treating hepatitis C. The Texas Health and Human Services Commission (HHSC) announced the prescription drug formulary update on Aug. 11, responding to advocacy by the Texas Medical Association and others in organized medicine to expand patient access to the drug.
Temple gastroenterologist Dawn Sears, MD, welcomes the news.
“To have a designated [DAA] for our Medicaid patients is life-saving and hugely saving in monetary ways in the state of Texas,” she said.
When the formulary update takes effect, all Medicaid patients with hepatitis C will be eligible for the preferred DAA drug, and any enrolled Medicaid physician or health care professional with delegated prescribing authority can prescribe the treatment, without having to obtain prior authorization or conduct a drug screening. All other DAA drugs will be designated in the formulary as “nonpreferred” and may still require prior authorization, according to HHSC.
“Removing that barrier of frustration and preauthorization and simply having one of the drugs that has been picked and already approved allows us to have more clean conversations with patients,” Dr. Sears said, adding that onerous preauthorization requirements often tie up physicians’ time and delay patients’ access to care.
This policy change builds on previous progress. After years of advocacy by TMA and others, the Texas Legislature allocated $51 million in the 2022-23 state budget to increase the availability of DAAs to treat Medicaid patients with hepatitis C.
With more money to cover the cost of the drugs, HHSC announced changes to Texas Medicaid’s hepatitis C prior authorization criteria in June 2021, including:
- Expanding access to DAA drugs regardless of a patient’s METAVIR fibrosis score, which measures the severity of fibrosis seen on a liver biopsy;
- Expanding DAA prescribing privileges to primary care physicians and health care professionals, rather than limiting them to specialists;
- Eliminating a drug screening requirement; and
- Eliminating a refill authorization requirement.
Together, these changes have helped transform hepatitis C treatment from a very complex process to one that is much simpler – and more effective.
“To know that any of our colleagues, not simply [those in] infectious disease and hepatology, can play a significant role in curing hepatitis C was a pipe dream a decade ago,” Dr. Sears said. “Treatment is now straightforward and, with access getting straightforward, our patients will win.”
More than half a million Texans are believed to have chronic hepatitis C, which is a common cause of liver disease and liver transplantation, according to the 2022 State Plan for treating the disease. And their numbers are growing. Across the U.S., the number of new hepatitis C infections reported to the Centers for Disease Control and Prevention nearly quintupled between 2010 and 2019.