Advocates Push to End Prior Authorization Requirement for Hepatitis C Cures

On Thursday, in coalition with over 100 healthcare providers and organizations, Legal Council for Health Justice urged the Illinois Department of Healthcare and Family Services to end its use of prior authorization criteria for the drugs that cure the hepatitis C virus (HCV).

HCV has infected over 3 million Americans, and it can lead to liver cirrhosis, cancer, and death. Fortunately, there is a treatment for HCV that is nearly 100% effective. HCV has a once daily, 8-week to 12-week oral treatment that can cure nearly all patients, reducing their risk of HCV-related cancer and death to effectively zero. These drugs can be safely prescribed by primary care providers in the patient’s own medical home. There is a national push to increase HCV screening and treatment to get HCV eradicated by 2030.

Unfortunately, Illinois is nowhere near eradicating HCV by 2030. To access this cure within the Illinois Medicaid program, you have to pass a series of hurdles. Illinois Medicaid requires prescribers to complete the prior authorization (PA) process to access these safe cures. This involves additional testing with tight timeframes, specialty consults, and paperwork obligations that delay access to the treatment by months.

And we know that the PA requirement disproportionately hurts people of color. The Centers for Disease Control studied access to HCV treatment, and came to two troubling conclusions. First, the CDC confirmed that people who are insured by Medicaid have a harder time accessing these cures than other insurance plans. Second, the CDC determined that within Medicaid, people who are not white are less likely to receive these cures than white Medicaid participants. The CDC concluded that removing barriers like the PA requirement for HCV treatment is critical to addressing this known source of racial treatment disparity.

It is time for Illinois HFS to act. Indiana, Wisconsin, Michigan, Missouri, and twelve other Medicaid programs have ended the use of prior authorization for HCV cures. Medicaid covers 1 in 4 Illinoisans and we all deserve timely access to this life-saving treatment. Only with HFS’s leadership will Illinois address the HCV disparities encountered by Illinois providers and laid bare by the CDC’s report.