21 Sep

New York Increases Access to Hepatitis C Treatment for Medicaid Patients

State of HEPC News

New York State Medicaid recently removed prior authorization requirements for new patients, increasing opportunities for individuals to be treated and cured of hepatitis C.

September 21, 2020 – The National Viral Hepatitis Roundtable (NVHR), the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI), and the Treatment Action Group (TAG) today applauded New York State (NYS) Medicaid for removing the requirement that new patients receive prior authorization approval for hepatitis C treatment. Additionally, NYS Medicaid will no longer impose sobriety screening requirements, which will help increase access to hepatitis C treatment for 223,700 individuals living with hepatitis C in New York.

“Removing prior authorization requirements is an important step in expanding access to hepatitis C treatment and we look forward to this policy being equally implemented across payors,” said NVHR Policy Manager Adrienne Simmons, PharmD. “By also eliminating the need for substance use screening, NYS Medicaid is removing discriminatory policies that propagated stigma and contradicted the standard of care.”

Prior authorization is a tool used by payors and insurance companies to determine if they will cover a prescribed procedure, treatment or medicine. In many cases, even if a clinician recommends a patient for hepatitis C treatment, Medicaid payors can deny coverage, which can lead to worse health outcomes for patients.

“Prior authorization requirements put payors in control of prescribing decisions, when clinical providers and patients should be making health care decisions together. Removing prior authorizations for first time treatment with direct acting antivirals for hepatitis C will shorten the time from diagnosis to cure and help New York State fulfill our commitment to ending the deadly hepatitis C epidemic,” said Annette Gaudino, Director of Policy Strategy at the Treatment Action Group.

However, current differences in coverage among fee-for-service and managed care organization programs continue creating barriers to universal access for hepatitis C treatment. With the new policy to remove prior authorization for preferred direct acting antivirals, NYS Medicaid payors have an opportunity to ensure coverage parity across programs. 

“It is encouraging to see New York remove prior authorization requirements for first time hepatitis C treatment patients and help reduce further health complications and liver cancer,” said Robert Greenwald, Clinical Professor of Law at Harvard Law School and the director of CHLPI. “We encourage all payors and providers to immediately implement the new policies to help improve public health outcomes, especially during the coronavirus pandemic.”

For more information about NYS Medicaid hepatitis C treatment requirements, please visit https://stateofhepc.org/report/#NewYork.

As of February 2024, 28 states have removed prior authorization for first-time treatment: AK, AZ, CA, CO, CT, DC, DE, FL, HI, ID, IL, IN, KS, LA, MA, MI, MO, NC, NH, NY, OK, OR, PA, RI, TX, VA, WA, WI.