1 / 10

Challenges

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

duer
Download Presentation

Challenges

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Co-occurring Challenges: Leveraging ADAP and ACA to Address Hepatitis C and Substance Use DisordersDaniel RaymondPolicy DirectorHarm Reduction Coalitionraymond@harmreduction.org

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. Role of ADAP: Insurance Support (premiums/cost-sharing) 2013 ASAM report on MAT coverage • Medicaid: incomplete coverage (17 states don’t 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

  9. 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)

  10. 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

More Related