Transcript Intimate Partner Violence & HIV Prevention with LGBT

Co-occurring Challenges: Leveraging
ADAP and ACA to Address Hepatitis C
and Substance Use Disorders
Daniel Raymond
Policy Director
Harm Reduction Coalition
[email protected]
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
Hepatitis C Co-infection
• Roughly 25% of HIV+ in United States coinfected 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
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
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
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
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
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
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)
Additional resources
NASTAD ADAP Monitoring Project
https://www.nastad.org/resources.aspx?category=National%20ADAP%20Monitoring%20
Project%20Annual%20Report
AASLD/IDSA Hepatitis C Treatment Guidance
http://www.hcvguidelines.org/
ASAM Advancing Access to Addiction Medications
http://www.asam.org/advocacy/aaam