Introduction
A total of 23 state Medicaid programs continue to restrict hepatitis C virus (HCV)
medication access by liver disease or substance-use criteria, creating obstacles to
HCV elimination and significant care disparities. Because public insurers often set
precedents for private insurer coverage and clinician practice patterns, this study
sought to analyze whether spillover occurs from state Medicaid HCV treatment restrictions
to HCV screening and treatment rates in commercially insured individuals.
Methods
Investigators analyzed 2014‒2017 commercial claims data across 48 U.S. states (721,961,965
person-months) and used an interrupted times series design to compare hepatitis C
virus screening and treatment rates before and after state Medicaid HCV treatment
policy changes, adjusting for state-level random effects, Medicaid expansion status,
and state drug overdose incidence rates, in states that relaxed Medicaid policy over
the study period. Analysis occurred during 2019‒2021.
Results
Hepatitis C virus screening rates among commercially insured individuals increased
after the corresponding state Medicaid program relaxed HCV treatment policy. Among
states that changed Medicaid policy, those that reduced fibrosis or both fibrosis
and abstinence restrictions experienced increased HCV screening rates by the study
end compared with states that changed only abstinence restrictions (rate ratio=1.29;
95% CI=1.15, 1.44; and rate ratio=1.32; 95% CI=1.17, 1.50, respectively). Similar
patterns did not occur in HCV treatment rates, which declined after 2015 across groups.
Conclusions
These data show that HCV screening rates increased among commercially insured individuals
after the removal of Medicaid HCV treatment restrictions in the same state. This suggests
that Medicaid treatment policies can spill over to affect health outcomes among commercially
insured populations.
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Article Info
Publication History
Published online: June 17, 2022
Identification
Copyright
© 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
