Examination of Fiscal Management and the Allocation of Care Act Resources US Department of Health and Human Services: Health REsources and Services Administration
INTRODUCTION
HIV/HCV Coinfection
HCV Treatment
Expanding Access to Treatment
Barriers and Key Issues
HCV Treatment: Estimating the Cost
Working With Patients Who Have Multiple Needs
Concerns About Relapse to Active Drug Use and Reinfection
Depression and HCV Treatment
Treatment Eligibility and Uptake
Treating Anemia and Neutropenia With Growth Factors
Access to HCV Treatment and ADAPs
Conclusion
Resources
References

Access to HCV Treatment and ADAPs

Currently, 20 State ADAPs provide access to interferon; 17 States also cover pegylated interferon and ribavirin. Many ADAPs provide access to at least some of the drugs needed to manage side effects of HCV treatment along with vaccinations for HAV and HBV. Table 7 provides a list of which drugs are available in each State as of March 2006.

According to a survey from the National Association of State and Territorial AIDS Directors (NASTAD), only 216 ADAP participants were being treated for HCV during July 2004. The following reasons were cited for low treatment uptake:

  • Side effects of the medication (n=6)
  • Patients and providers not aware that HCV treatment had recently been added to the formulary (n=4)
  • Providers not treating HCV or not trained in treating HCV (n=2)
  • Provider requiring liver biopsy created a barrier to treatment (n=1)
  • Client eligible for patient assistance programs (n=1)
  • Preferred drugs not included on the formulary (n=1; California’s ADAP does not cover pegylated interferon).163

To offer HCV treatment in the context of limited resources, some ADAPs have developed cost-containment measures for their HCV programs. For example, Maryland’s ADAP has medical eligibility criteria stating that the patient’s HCV infection must, “in the judgment of the clinician . . . be expected to be eradicated. . . . Treatment for histological benefit alone is not eligible.” The physician must “treat to cure,” not to maintain the patient’s current condition. Maryland’s ADAP also requires a liver biopsy for genotype 1. So far, HCV treatment uptake has been limited: Only $35,000 of the $2,000,000 dedicated to HCV treatment was used in 2005.164 The Washington State ADAP has implemented a monthly copayment of $10.00 to $25.00, based on income, for all formulary drugs; the copayment is collected at the pharmacy.

State ADAP programs report that financial impact of adding HCV treatment to their formularies has been minimal. As of September 2001, ADAP programs in New York, California, Massachusetts, and New Jersey reported that they were spending less than 1 percent on HCV treatment.165

ADAP Coverage Table

 
 
<< Treating Anemia and Neutropenia With Growth Factors • Conclusion >>