Public reimbursement policies in Canada for direct-acting antiviral treatment of hepatitis C virus infection: A descriptive study.

Background

Direct-acting antiviral (DAA) therapies have simplified HCV treatment, and publicly funded Canadian drug plans have eliminated disease-stage restrictions for reimbursement of DAA therapies. However other policies which complicate, delay, or prevent treatment initiation still persist. We aim to describe these plans' existing reimbursement criteria and appraise whether they hinder treatment access.

Methods

We reviewed DAA reimbursement policies of 16 publicly funded drug plans published online and provided by contacts with in-depth knowledge of prescribing criteria. Data were collected from May to July 2022. Primary outcomes were: (1) if plans have arranged to accept point-of-care HCV RNA testing for diagnosis; testing requirements for (2) HCV genotype, (3) fibrosis stage, and (4) chronic infection; (5) time taken and method used to approve reimbursement requests; (6) providers eligible to prescribe DAAs; and (7) restrictions on re-treatment.

Results

Fifteen (94%) plans have at least one policy in place which limits simplified HCV treatment. Many plans continue to require results of genotype or fibrosis staging, limit eligible prescribers, and take longer than 1 day to approve coverage requests. One plan discourages treatment for re-infection.

Conclusion

Reimbursement criteria set by publicly funded Canadian drug plans continue to limit timely, equitable access to HCV treatment. Eliminating clinically irrelevant pre-authorization testing, expanding eligible prescribers, expediting claims processing, and broadening coverage of treatment for reinfection will improve access to DAAs. The federal government could further enhance efforts by introducing a federal HCV elimination strategy or federal high-cost drug PharmaCare program.

Informations de copyright

© Canadian Association for the Study of the Liver, 2023.

Déclaration de conflit d'intérêts

SR Bartlett has advised and spoken for Gilead Sciences and AbbVie (all personal payments given as unrestricted donations to BC Centre for Disease Control Foundation for Public Health) and has received investigator-initiated research funding from Gilead Sciences and AbbVie via her institution. CL Cooper has advised, spoken for, and received unrestricted clinical and research funding from Gilead Sciences and AbbVie. N Kronfli receives research funding from Gilead Sciences, advisory fees from Gilead Sciences, ViiV Healthcare, Merck, and AbbVie, and speaker fees from Gilead Sciences, AbbVie, and Merck, all outside of the submitted work. J Butler-McPhee has advised Gilead Sciences and Abbvie, and has received unrestricted research funding from Gilead Sciences, all outside of the submitted work. J Grebely is a consultant/advisor and has received research grants from AbbVie, Biolytical, Camurus, Cepheid, Gilead Sciences, Hologic, Indivior, and Merck, all outside the submitted work. All other authors have no other relevant interests to disclose. J Feld is a consultant/advisor and has received research grants from Gilead and AbbVie.