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The new hepatitis C virus (HCV) treatment regimens are safe and highly effective but costly. Because of their high price, many insurers, including Medicaid, have implemented coverage restrictions and prior-authorization requirements.
To systematically evaluate state Medicaid policies for HCV treatment with sofosbuvir in the U.S., investigators searched state Medicaid websites for reimbursement criteria data from the 50 states and the District of Columbia. Data were limited to Medicaid fee-for-service beneficiaries only.
Reimbursement criteria were publicly available in 42 states, including D.C. (82%). Nine states provided no information regarding their criteria, and Nevada did not have reimbursement criteria. Among the 42 programs with restri…