Impact of the Removal of Hepatitis C (HCV) Treatment Restrictions on Progression through the HCV Care Continuum

Monday, June 15th 2020

1:00 PM - 2:30 PM


In January 2018, Pennsylvania Medicaid removed disease severity criteria from prior authorization criteria for Hepatitis C virus (HCV) treatment. To assess the impact of this change, we compared the rates of progression through the HCV care cascade during the year prior and after January 1, 2018 in patients treated in a Federally Qualified Health Center (FQHC) in Philadelphia, PA. We also compared the progression through the cascade in those identified through a community-based testing (CBT) program to those tested in the FQHC.Subjects included all HCV RNA positive adults tested between 1/1/2017 and 12/31/2018 by our CBT program and navigated to the FQHC (Group 1) and tested within the FQHC (Group 2). Each group was evaluated for progression through the HCV care continuum during two time periods, 1/1/2017-12/31/2017 and 1/1/2018-12/31/201. We compared rates of insurance approval and treatment initiation for Groups 1 and 2 using Chi square testing and compared the mean time to each milestone using an unpaired t-test.The removal of the PAM disease severity restrictions resulted in an increase in treatment approval and treatment initiation rates, particularly significant in subjects tested for HCV in community settings (Figure 1). In addition, there was a significant decrease in time to treatment initiation among all subjects diagnosed with chronic HCV and a significate decrease in time to initial HCV visit among subjects tested in the community after removal of restrictions. Despite these decreases in time to achieving critical milestones, HCV treatment linkage rates among patients navigated from the community continue to be lower than patients tested within the FQHC. These ongoing delays to care suggest that test and treat models should be developed and evaluated.


Alexandra Ripkin

Alexandra Ripkin has been with Philadelphia FIGHT since 2016. She currently works as Project Coordinator with C a Difference, FIGHT’s comprehensive hepatitis C (HCV) testing and linkage-to-care program. She coordinates HCV treatment for FIGHT patients across clinical settings, manages data for daily operations and research dissemination, and collaborates on harm reduction projects throughout FIGHT programs. Alexandra has also previously assisted with the establishment of the satellite primary care clinic at Broad Street Ministry and served as Program Manager of Clínica Bienestar, the HIV primary care clinic within Prevention Point Philadelphia. Alexandra graduated from Temple University with duel Master’s degrees in Public Health and Social Work.

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Karam Mounzer, MD

Dr. Mounzer identified two major gaps in the care of patients with HIV/hepatitis C (HCV) co-infection, and the complexity of multidrug-resistant HIV treatment. He is involved with many clinical trials focusing on drug development and better understanding of HIV immunopathogenesis with the Wistar Institute. He is involved in teaching and mentoring.

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Dr. Karam Mounzer

Dr. Mario Cruz

Dr. Mario CruzDr. Cruz is a board certified pediatrician who serves as the Medical Director for our Pediatrics and Adolescent Health Center. He has presented and/or published in the fields of community violence and domestic violence prevention, quality improvement, behavioral health, curriculum development and mentorship. In 2019 he received the Greater Philadelphia Social Innovation Award for Innovations in Healthcare.

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