New research from the University of Pennsylvania Perelman School of Medicine shows that 50% of Medicaid patients infected with chronic hepatitis C were denied coverage of newer, life-saving antiviral drugs prescribed by their doctors. Explanations included that the therapies were not considered “a medical necessity,” the patients had tested positive for alcohol/drugs, and other reasons. Researchers analyzed the hepatitis C prescriptions submitted to a large specialty pharmacy between November 2014 and April 2015 from 2,342 patients in Maryland, Delaware, Pennsylvania, and New Jersey. Overall, insurers denied 16% of prescriptions for the drugs, which includes the results of appeals that were filed after initial denials. The proportion of Medicaid denials, however, was much higher at 46%.

This is the first data of its kind to report delay and denial rates in a cohort of Medicaid, Medicare, and privately insured patients for the class of hepatitis C drugs known as direct-acting antiviral agents, therapies with very successful cure rates and high costs. For more information view the news release here.