Theme: Models of Care Year: 2019
Background: In the U.S., a minority of HCV-infected persons with opioid use disorder undergo HCV
treatment. Co-located HCV and opioid agonist therapy (OAT) along with harm reduction (HR) can
facilitate prevention and cascade to cure. Rhode Island (RI) Medicaid (federal/state health insurance for
low-income persons) supplied DAAs only for persons with F3/F4 fibrosis and either non-drug/alcohol use
for 6 months or addiction treatment, until July 1, 2018, when DAA restrictions were lifted.
Description of model of care/intervention: The physician-nurse team added a pharmacist in August
2018 to assist with the 30-minute per DAA prescription Prior Authorization (PA) process (11 different
PAs, 9 public, 2 private payer) at our integrated HCV/OAT/HR clinic, at RI’s only non-profit methadone
maintenance program (MMP). We conducted a retrospective chart review comparing DAA treatment
pre-and-post July 1, 2018.
Effectiveness: From April 2014-March 2019, the physician-nurse team evaluated 376 patients, mean
age 43 (21-71 years), 34% female. 237 initiated DAAs, mean age 44 (21-71 years), 34% female,
genotypes 1a (57%), 1b (6%), 2 (7%), 3 (21%), 4 (7%), 6(<1%), mixed (1%); 98% had public health
insurance (92% Medicaid, 6% Medicare), 2% private; 163/175 (93%) achieved SVR (30 on treatment or
post-treatment follow-up before SVR12, 44 lost to follow-up).
Pre-July 1, 2018: 72 patients initiated DAAs (22% of patients seen), mean age 54, 26% female, 68%
F3/F4. Post-July 1, 2018: 70 patients initiated treatment (60% of patients seen), mean age 38, 37%
female, 7% F3/F4. Ninety-five patients treated via research studies providing DAAs were excluded from
pre-post Medicaid DAA access analysis (all Medicaid recipients).
Conclusion: Removing DAA restrictions and incorporating a pharmacist facilitates DAA treatment in an
HCV clinic embedded in a MMP. Younger persons access treatment before advanced fibrosis develops,
reducing potential years of HCV transmission. The U.S. time-intensive PA process remains a barrier to
expanding capacity.
Disclosure of Interest Statement: No pharmaceutical grants were received in the development of this
study. This work was supported in part by the University of Rhode Island College of Pharmacy
Healthcare Research Operating Fund.