Co-occurring Challenges: Leveraging ADAP and ACA to Address Hepatitis C and Substance Use Disorders
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Co-occurring Challenges: Leveraging ADAP and ACA to Address Hepatitis C and Substance Use Disorders Daniel Raymond Policy Director Harm Reduction Coalition [email protected] Challenges. Hepatitis C co-infection is a leading cause of mortality in people living with HIV/AIDS

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Challenges

Co-occurring Challenges: Leveraging ADAP and ACA to Address Hepatitis C and Substance Use DisordersDaniel RaymondPolicy DirectorHarm Reduction [email protected]


Challenges

Challenges

  • Hepatitis C co-infection is a leading cause of mortality in people living with HIV/AIDS

  • Substance use disorders magnify gaps in the HIV Care Continuum

  • ARV access is necessary but not sufficient


Hepatitis c co infection

Hepatitis C Co-infection

  • Roughly 25% of HIV+ in United States co-infected with chronic HCV

  • HIV co-infection worsens HCV outcomes, and HCV-related liver disease is a leading cause of non-AIDS-related death in PLWHA

  • New HCV treatments are increasingly effective and well-tolerated


Substance use disorders

Substance Use Disorders

  • Substance use disorders are highly prevalent among PLWHA

  • Untreated SUDs impede linkage & retention in care, receipt of ARV, and adherence

  • An estimated 25% of PLWHA are in need of treatment for an alcohol or substance use disorder


Medications of interest

Medications of Interest

  • Current HCV regimens:

    Genotype 1: Sovaldi/PEG/RBV, Olysio/PEG/RBV, Sovaldi/Olysio +/- RBV, Sovaldi/RBV

    Genotype 2/3: Sovaldi/RBV

  • Medication-assisted treatment for opioid use disorders: methadone, buprenorphine, naltrexone


Role of adap direct purchase

Role of ADAP: Direct Purchase

  • Limited coverage of HCV direct-acting antivirals: in 2012, only 8 states covered telaprevir and/or boceprevir (roughly half covered pegylated interferon)

  • Extremely limited coverage of methadone and/or buprenorphine


Role of adap insurance support premiums cost sharing

Role of ADAP: Insurance Support (premiums/cost-sharing)

  • HCV direct-acting antivirals: dynamic environment as new regimens enter market

  • Payer resistance re: cost of new drugs, volume of potential patient population

  • HCV drugs typically under PA requirements, higher specialty tiers

  • Concerns re: clinical criteria, fail first/step therapy


Role of adap insurance support premiums cost sharing1

Role of ADAP: Insurance Support (premiums/cost-sharing)

2013 ASAM report on MAT coverage

  • Medicaid: incomplete coverage (17 states don‚Äôt cover methadone; majority require PA for buprenorphine; lifetime/dosage limits)

  • Commercial plans: methadone typically not covered; buprenorphine subject to PA, dosage limits, specialty tier, other restrictions


Adap aca interaction

ADAP/ACA Interaction

How to guarantee access & affordability for HCV treatment & MAT for opioid use disorders?

  • Monitor plan design (formulary & network) for care & coverage

  • Track utilization & barriers to access

  • Understand protections (discrimination; Mental Health Parity & Addiction Equity Act)


Additional resources

Additional resources

NASTAD ADAP Monitoring Project

https://www.nastad.org/resources.aspx?category=National%20ADAP%20Monitoring%20Project%20Annual%20Report

AASLD/IDSA Hepatitis C Treatment Guidance

http://www.hcvguidelines.org/

ASAM Advancing Access to Addiction Medications

http://www.asam.org/advocacy/aaam


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