In this week’s JAMA Network Open, Kapadia et al analyzed Medicaid claims to assess who was more or less likely to receive Hep-C anti-viral treatments. These treatments are remarkably effective. The current standard of care is that individuals should be on these drugs as soon as they are diagnosed with Hep-C. That is not the case:
Of the included patients, 43 078 (49%) were females, 12 355 (14%) were age 18 to 29 years, 35 181 (40%) were age 30 to 49 years, 51 282 (46%) were non-Hispanic White, and 48 840 (49%) had an IDU diagnosis. Additionally, 17 927 patients (20%) received HCV treatment within 6 months of their HCV diagnosis. Patients who initiated HCV treatment were more likely to be older, male, and less likely to have IDU [my emphasis added]
The time frame that the researchers looked at was 2017 through 2019. This is after the OH MY GOD THESE DRUGS ARE HYPER EXPENSIVE shock when Solvaldi came on the market at the price of the starting annual base salary for an assistant professor in health policy at a mid tier school. By the time the study period started, there were multiple Hep-C drugs on the market, rebates were massive and there were authorized generics in the pipeline. These drugs aren’t cheap even after their net price got knocked down massively, but they are extremely cost-effective over a several year time horizon.
Access to care is likely a function of social power. The authors examined the factors that were associated with the odds of receiving Hep-C treatments. They found that people who checked the boxes of older, male, white and urban were more likely to get guideline concordant care than others. Power likely matters.
Insurance helps, but it is not sufficient to get care that people need.