Will ‘Son of Sovaldi’ Cause State Medicaid Programs to Erect High Hurdles?
What did the report find? Many state Medicaid programs have been moving to restrict access to Sovaldi. Right now, prior authorization, a process in which a payer will first review the prescription before automatically covering the cost, is required by 35 states for the treatment, according to the report distributed by the Medicaid Health Plans of America.
In addition, several states require patients to meet a set of clinical or related criteria for prior authorization, according to the report. And most, if not all, states that require prior authorization for Sovaldi also require patients to undergo a liver biopsy to determine the severity of their disease before treatment can begin.
The report offers a few examples of prior authorization requirements: Alaska requires patients to abstain from illicit drug use and alcohol for at least three months and undergo a verifying urine test; Illinois requires patients to meet 25 different criteria; and in West Virginia, only a board-certified infectious disease physician, gastroenterologist or hepatologist may prescribe Sovaldi.
And of 17 states that have placed Sovaldi on its so-called list of preferred drugs for which reimbursement is available, 14 states require prior authorization. And of those 14 states, seven also places limits on the frequency, quantity and duration of prescribing. Some states, such as Arizona, have a ‘once-in-a-lifetime rule that allows Medicaid patients only chance at treatment.
Filed under: General Problems
Leave a Reply