Louisiana developing ‘Netflix’ style subscription plan for HCV treatment

Pete Croughan, MD
Pete Croughan

HCV Next spoke with the department’s chief of staff, Pete Croughan, MD, about the landscape of HCV in the state and the novel payment model designed to expand treatment despite the expensive cost of direct-acting antivirals.

“Hepatitis C is definitely an epidemic here, like it is in many places, and equally tied to the opioid epidemic due primarily to transmission through reuse of needles,” Croughan told HCV Next. “National data has shown that rates of acute infections tripled in the last 5 years. This corresponds with our own internal data on increased rates of infection.”

While the state has adequate data on the number of individuals infected with HCV through Medicaid, Croughan explained that the health department is focused on improving surveillance in correctional facilities, which is significantly lacking. National data, he said, place HCV prevalence in correctional facilities between 15% and 40%. Until screening is expanded in Louisiana, “we’re not going to know how many people are infected with HCV in our justice system,” he said.

Prior authorization criteria had also presented a barrier to treatment for state residents. Like many states, prior authorization initially restricted treatment based on at least 1 year of sobriety, prescriber specialty and the patient’s fibrosis score. However, cost-effective data that followed the introduction of new DAAs led the health department to evaluate what criteria was the most restrictive and least evidence-based with the help of the physician community and health advocates in New Orleans.

“We wound up changing our sobriety restriction to only needing a provider access statement that the patient is able to complete treatment, we removed the provider specialty restriction, and we eliminated fibrosis scores for HCV and HIV-coinfected individuals,” Croughan said. “Our hope is to eliminate this disease — that’s been our goal from the beginning — but the challenge has been how to pay for it. We’re among the poorer states and we’re trying to find space to treat large numbers of people. That’s where we think the subscription model in a win-win-win, for patients, the state and potentially pharmaceutical partners.”

Working with Rebekeh Gee, MD, Secretary of the Louisiana Department of Health, Croughan and colleagues developed the concept of a subscription payment model that has been described by some as the “Netflix model.