{"id":200162,"date":"2021-08-27T15:08:00","date_gmt":"2021-08-27T19:08:00","guid":{"rendered":"https:\/\/www.bu.edu\/sph\/?post_type=bu-article&#038;p=200162"},"modified":"2021-08-26T18:21:45","modified_gmt":"2021-08-26T22:21:45","slug":"subscription-based-payment-models-may-improve-access-to-hepatitis-c-medications","status":"publish","type":"bu-article","link":"https:\/\/www.bu.edu\/sph\/news\/articles\/2021\/subscription-based-payment-models-may-improve-access-to-hepatitis-c-medications\/","title":{"rendered":"Subscription-Based Payment Models May Improve Access to Hepatitis C Medications"},"content":{"rendered":"\t<div class=\"wp-block-editorial-leadin sphnews-block-editorial-leadin is-style-default has-media has-media-focus-center-middle has-light-theme\">\n\t\t<div class=\"container-lockup\">\n\n\t\t\t<div class=\"wp-block-leadin-media\">\n\t\t\t\t\n\t\t\t\t<img width=\"2560\" height=\"1706\" src=\"\/sph\/files\/2021\/08\/hep-c-medicaid-scaled.jpg\" class=\"\" alt=\"\" loading=\"lazy\" srcset=\"https:\/\/www.bu.edu\/sph\/files\/2021\/08\/hep-c-medicaid-scaled.jpg 2560w, https:\/\/www.bu.edu\/sph\/files\/2021\/08\/hep-c-medicaid-636x424.jpg 636w, https:\/\/www.bu.edu\/sph\/files\/2021\/08\/hep-c-medicaid-1024x683.jpg 1024w, https:\/\/www.bu.edu\/sph\/files\/2021\/08\/hep-c-medicaid-768x512.jpg 768w, https:\/\/www.bu.edu\/sph\/files\/2021\/08\/hep-c-medicaid-1536x1024.jpg 1536w, https:\/\/www.bu.edu\/sph\/files\/2021\/08\/hep-c-medicaid-2048x1365.jpg 2048w, https:\/\/www.bu.edu\/sph\/files\/2021\/08\/hep-c-medicaid-755x503.jpg 755w, https:\/\/www.bu.edu\/sph\/files\/2021\/08\/hep-c-medicaid-1500x1000.jpg 1500w, https:\/\/www.bu.edu\/sph\/files\/2021\/08\/hep-c-medicaid-900x600.jpg 900w, https:\/\/www.bu.edu\/sph\/files\/2021\/08\/hep-c-medicaid-450x300.jpg 450w, https:\/\/www.bu.edu\/sph\/files\/2021\/08\/hep-c-medicaid-600x400.jpg 600w, https:\/\/www.bu.edu\/sph\/files\/2021\/08\/hep-c-medicaid-1920x1280.jpg 1920w, https:\/\/www.bu.edu\/sph\/files\/2021\/08\/hep-c-medicaid-1200x800.jpg 1200w\" sizes=\"(max-width: 2560px) 100vw, 2560px\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\n\t\t\t\n\t\t\t\t<div class=\"container-words-outer\">\n\n\t\t\t\t\t\n\t\t\t\t\t<div class=\"container-words-inner\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"wp-prepress-tag\">healthcare costs<\/span>\n\t\t\t\t\t\t\t\t<h1 class=\"head\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tSubscription-Based Payment Models May Improve Access to Hepatitis C Medications\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/h1>\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t<h4 class=\"deck\">The alternative payment model enables states to negotiate reduced prices with a single drug manufacturer in exchange for exclusive treatment for a state&#8217;s Medicaid population.<\/h4>\n\t\t\t\t\t\t\n\t\t\t\t\t<\/div>\n\n\t\t\t\t<\/div>\n\n\t\t\t\n\t\t<\/div>\n\n\t\t\n\t<\/div>\n\n\t\n<div class=\"wp-prepress-component-metabar sphnews-prepress-layout-metabar\">\n\t<div class=\"wp-prepress-component-metabar-wrapper\">\n\t\t\t\t\t<div class=\"wp-prepress-component-metabar-date\">August 27, 2021<\/div>\n\t\t\n\t\t\t\t<div class=\"wp-prepress-component-metabar-credits\">\n\t\t\t\t\t\t\t\t<ul data-credit-type=\"By\">\n\t\t\t\t\t\t<li><a href=\"https:\/\/www.bu.edu\/sph\/news\/authors\/jillian-mckoy\/\">Jillian McKoy<\/a><\/li>\n\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"wp-prepress-component-metabar-share js-bu-prepress-share-tools\">\n\t\t\t<span class=\"icon-twitter\"><span>Twitter<\/span><\/span>\n\t\t\t<span class=\"icon-facebook\"><span>Facebook<\/span><\/span>\n\t\t\t<span class=\"icon-action\"><\/span>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\t\n\n\n<p>The development of direct-acting antiviral (DAA) agents revolutionized treatment for the hepatitis C virus (HCV) in 2013, changing the disease from one that can be controlled to one that can be cured. But with a list price of $25,000 to $95,000 per prescription, state Medicaid programs\u2014which insure a disproportionate number of people with HCV\u2014have imposed strict limitations on who can qualify for these medications.<\/p>\n\n\n\n<p>Subscription-based payment models (SBPM), a novel approach in which states contract exclusively with a single manufacturer to supply prescriptions at a reduced price, could increase access to these life-saving treatments, according to a new School of Public Health study. In a SBPM, states pay reduced per prescription prices for medications until a certain utilization threshold. After this threshold, the cost of additional prescriptions is essentially zero.<\/p>\n\n\n\n<p><a href=\"https:\/\/jamanetwork.com\/journals\/jama-health-forum\/fullarticle\/10.1001\/jamahealthforum.2021.2291?utm_source=For_The_Media&amp;utm_medium=referral&amp;utm_campaign=ftm_links&amp;utm_term=082721\" target=\"_blank\" rel=\"noreferrer noopener\">Published in the journal <em>JAMA Health Forum<\/em><\/a>, the study examined changes in Medicaid-covered HCV prescription fills in Louisiana and Washington after the two states implemented SBPMs in July 2019. While Washington did not experience a significant change in quarterly HCV prescription fills, Louisiana\u2019s prescription fills increased by 534 percent.<\/p>\n\n\n\n<p>\u201cWith subscription-based payment models, there&#8217;s no incentive to ration access because there is almost no cost of additional prescriptions after the threshold,\u201d says study lead author <a href=\"https:\/\/twitter.com\/sam_auty\" target=\"_blank\" rel=\"noreferrer noopener\">Samantha Auty<\/a>, a doctoral candidate in the Department of Health Law, Policy &amp; Management. \u201cThis model actually incentivizes states to treat as many individuals who would benefit from HCV treatment as possible, which improves population health in a group of individuals who face structural barriers to care and aligns with the goals of the WHO to eradicate this virus by 2030.\u201d<\/p>\n\n\n\n<p>For the study, Auty and colleagues used publicly available Medicaid data from all 50 states and Washington, DC to compare changes in HCV prescription fills between the two states that implemented SBPMs and those that did not. The average rate of HCV prescription fills per 100,000 Medicaid enrollees rose from 43.1 to 206.0 in Louisiana and from 50.1 to 53.9 in Washington.<\/p>\n\n\n\n<p>The researchers say the differences in increased medication use between the two states may be explained by state variation in SBPM implementation, differences in the populations that qualified for HCV medication coverage prior to SBPMs in each state, and screening and treatment delays as a result of the COVID-19 pandemic. Louisiana lifted its liver damage and sobriety restrictions for HCV medication access simultaneously with SBPM adoption, while Washington removed these restrictions in 2016. Even when accounting for this change, Louisiana experienced an 180.2% increase in HCV prescription use following SBPM adoption.<\/p>\n\n\n\n<p>SBPMs are similar to the advance market commitment that the US adopted for its COVID vaccination strategy, in which the country pledged to purchase high-cost vaccines from select manufacturers, says Auty. The SBPM model appears to be a scalable solution that other states could apply to multiple public health issues, she says.<\/p>\n\n\n\n<p>\u201cOur results are evidence that SBPMs can work, and there are other epidemics in the US that could benefit from this type of model,\u201d Auty says. \u201cMedications for opioid use disorder saves many lives, as they reduce risk of overdose, death, and other comorbidities related to use. My hope is that these results provide support for the use of SBPMs not just for HCV, but for other high-value medications as well.\u201d<\/p>\n\n\n\n<p>The study was co-authored by <a href=\"https:\/\/www.bu.edu\/sph\/profile\/paul-shafer\/\">Paul Shafer<\/a>, assistant professor of health law, policy &amp; management, and Kevin Griffith, SPH alum and assistant professor of policy at Vanderbilt University Medical Center.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The development of direct-acting antiviral (DAA) agents revolutionized treatment for the hepatitis C virus (HCV) in 2013, changing the disease from one that can be controlled to one that can be cured. But with a list price of $25,000 to $95,000 per prescription, state Medicaid programs\u2014which insure a disproportionate number of people with HCV\u2014have imposed [&hellip;]<\/p>\n","protected":false},"author":15205,"featured_media":200182,"comment_status":"closed","ping_status":"closed","template":"","meta":{"bu_prepress_billboard":"","_bu_prepress_primary_term":"healthcare costs","_bu_prepress_primary_term_manual":""},"tags":[2178,2548,2023,2526,1794,1616],"bu-publication":[3516],"sphnews-article-category":[3519,3531,3535,3540],"sphnews-topic":[],"bu_edition":[],"media_type":[],"profile_tax":[3286],"_links":{"self":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/200162"}],"collection":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article"}],"about":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/types\/bu-article"}],"author":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/users\/15205"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/comments?post=200162"}],"version-history":[{"count":12,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/200162\/revisions"}],"predecessor-version":[{"id":200300,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/200162\/revisions\/200300"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media\/200182"}],"wp:attachment":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media?parent=200162"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/tags?post=200162"},{"taxonomy":"bu-publication","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-publication?post=200162"},{"taxonomy":"sphnews-article-category","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/sphnews-article-category?post=200162"},{"taxonomy":"sphnews-topic","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/sphnews-topic?post=200162"},{"taxonomy":"bu_edition","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu_edition?post=200162"},{"taxonomy":"media_type","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media_type?post=200162"},{"taxonomy":"profile_tax","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/profile_tax?post=200162"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}