Cost Pushback Limiting Hepatitis C Drug Utilization
Study finds 22% of patients prescribed drug therapy for HCV were not started on care or delayed 150-plus days beyond the writing of the prescription. Coverage decisions don't seem to be linked clearly to disease severity, but denials were higher among Medicaid patients and among certain private-sector plans.
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Potentially curative regenerative medicine therapies are no longer theoretical, but instead have become reality. As more and more gene, cell and tissue-based therapies reach the market, the need for payment solutions is becoming more pressing. The Alliance for Regenerative Medicine has consulted with payers and other stakeholders to consider the barriers to alternative payment models and look at possible solutions.
CMS requests information from hepatitis C manufacturers on how value-based purchasing arrangements might work in Medicaid. Agency also urges state Medicaid directors to relax overly strict coverage requirements for the drugs.
Pink Sheet reporters and editor discuss President-Elect Joe Biden’s decision to name the CDER director as acting FDA commissioner and other staffing changes, as well as changes to industry trade groups’ political donations.