Despite this simplification, many insurers include being a specialist as part of prior authorization requirements for DAA treatment.
CHERISH Research Affiliate and former pilot grant recipient Shashi N. Kapadia, CHERISH investigators Bruce R. Schackman and Yuhua Bao, and Phyllis Johnson and Kristen Marks of Weill Cornell Medicine conducted this retrospective study to identify whether the delivery or completion of an HCV treatment is associated with a provider’s specialty. Using real-world national data from the Healthcare Cost Institute (HCCI), the authors identified providers who prescribed HCV therapy and privately insured patients who had pharmacy claims for HCV treatment between 2013 and 2017.
The findings showed an increase in the number of providers treating HCV after DAAs were approved in 2014. Most of the providers prescribing treatment were gastroenterology specialists with a rising proportion of non-specialists: general medicine physicians increased from 319 (14%) in 2013 to 1,073 (17%) in 2017. The authors also saw similar treatment completion rates across specialties: more than 94% for gastroenterology and infectious diseases, general medicine and non-physicians, and other or unknown specialties. These findings suggest that non-specialist providers have a critical opportunity to offer effective HCV treatment and reduce hepatitis-related disparities as part of a national and global effort to eliminate viral hepatitis. This study provides additional evidence to support removing policies that restrict coverage of HCV treatment based on provider specialty.
This study was funded by a CHERISH pilot grant and awarded to Kapadia in 2018.