Engaging PCPs in HCV management with a resource-based provider toolkit

Nationally, an estimated 2.7-3.9 million people are living with chronic hepatitis C infection, a liver disease which can lead to cirrhosis, liver failure, and liver cancer. In addition to the 700,000 deaths per year from hepatitis C-related liver disease, rising rates of advanced liver disease complications and health care costs contribute to the growing burden of Hepatitis C Virus (HCV). Traditionally, HCV treatment with interferon drugs was poorly tolerated and ineffective for patients, and difficult for physicians to manage. More recently, new and well-tolerated treatments called direct-acting antiviral (DAA) agents have revolutionized HCV management with reported cure rates approaching 100%. While the notoriously high price tags on these DAA agents are a predominant barrier for patients, those with Medicaid health insurance fortunately receive coverage for these medications. As the cure for HCV becomes more accessible, the D.C. Department of Health’s HIV/AIDS, Hepatitis, STDs, and Tuberculosis Administration (DOH HAHSTA) is now mobilizing to create a five-year HCV Elimination Framework to eradicate HCV as a public health threat in the District. We first studied the eligibility criteria for Medicaid coverage of HCV DAAs among different D.C. Medicaid programs (AmeriHealth, Trusted, and Medicaid Fee-for-service) to better understand the resitrictions for these patients. We found that while Medicaid programs previously restricted patients to treatment by specialist physicians, programs are now relaxing restrictions so that patients may be prescribed by primary care providers (PCPs). Allowing prescriptions by PCPs prevents more loss to follow-up with patients who are tested to be HCV positive, as patients on Medicaid health insurance often face difficulty recieiving specialist care. HAHSTA is currently focusing on encouraging more PCPs to manage their patients’ HCV as a mode of increasing overall treatment rates and thus, cure rates in D.C. After assessments on PCP comfort and knowledge in HCV management, we developed a HCV Management Provider Toolkit, with resources including medication guidelines, prior authorization protocols, HCV treatment-to-cure algorithms. After finalization, this toolkit will be published on the D.C. DOH website and printed and distributed to local PCP offices