Table 2.
Outcomes of prescription of direct-acting antiviral therapy.
| P-value | ||||||
|---|---|---|---|---|---|---|
| Event | Overall (n=2,321) | US Medicaid (n=503) | US Medicare (n=795) | Commercial (n=1,023) | Medicaid vs. Medicare | Medicaid vs. Commercial |
|
| ||||||
| No denial of DAA prescription by insurer | 1,631 (70.3%) | 147 (29.2%) | 652 (82.0%) | 832 (81.3%) | <0.001 | <0.001 |
| Any denial of DAA by insurer | 690 (29.7%) | 356 (70.8%) | 143 (18.0%) | 191 (18.7%) | <0.001 | <0.001 |
| Insurer denial of DAA preceding fill | 313 (13.5%) | 123 (24.5%) | 103 (13.0%) | 87 (8.5%) | <0.001 | <0.001 |
| Absolute denial of DAA by insurer | 377 (16.2%) | 233 (46.3%) | 40 (5.0%) | 104 (10.2%) | <0.001 | <0.001 |
| Reason reported by insurer | <0.001 | <0.001 | ||||
| Insufficient information to assess medical need | 134 (35.5%) | 112 (48.1%) | 7 (17.5%) | 16 (15.4%) | ||
| Lack of medical necessity | 132 (35.0%) | 72 (30.9%) | 12 (30.0%) | 48 (46.2%) | ||
| Positive drug screen | 15 (4.0%) | 9 (3.9%) | 0 (0%) | 6 (5.8%) | ||
| Not preferred DAA | 10 (2.7%) | 2 (0.8%) | 4 (10.0%) | 4 (3.8%) | ||
| Unknown, no denial letter received by pharmacy | 86 (22.8%) | 38 (16.3%) | 17 (42.5%) | 30 (28.8%) | ||
| DAA prescription ultimately filled | 1,944 (83.8%) | 270 (53.7%) | 755 (95.0%) | 919 (89.8%) | <0.001 | <0.001 |
Abbreviation: DAA, direct-acting antiviral