Access to hepatitis C direct-acting antiviral therapy in hepatitis C-positive donor to hepatitis C-negative recipient solid-organ transplantation in a real-world setting

• DOI: 10.1016/j.amjsurg.2021.09.005
• Publication Date: 2021-09-14T05:13:47Z
• Authors: Cori Edmonds; Alicia Carver; Josh DeClercq; Leena Choi; Megan Peter; Kelly Schlendorf; Roman Perri; Rachel C. Forbes; Beatrice P. Conce...
• Keywords: 03 medical and health sciences; 0302 clinical medicine; Humans; Hepacivirus; Organ Transplantation; Hepatitis C, Chronic; Antiviral Agents; Hepatitis C; Tissue Donors; Retrospective Studies; 3. Good health

Emerging data supports expanding the solid organ donor pool with transplantation from hepatitis C virus (HCV)-positive donors into HCV-negative recipients. However, concerns exist regarding the ability to access direct-acting antivirals (DAAs) post-transplant in a real-world setting.This single-center, retrospective study evaluated DAA access rates, time to first dose, and patient cost in donor-derived HCV solid-organ transplant recipients utilizing an integrated specialty pharmacy process.Among 91 patients, all accessed DAAs through prescription insurance (97%) or patient assistance programs (3%). Of those who received DAAs through insurance, only 65% received approval on initial insurance submission. Median time from transplant to first dose was 45d [IQR 34-66]. The on-site specialty pharmacy was used by 69% of patients. Copay assistance programs reduced the median monthly patient cost from $1914 [range $7-7536] to $0 [range $0-5].Our findings indicate that access to DAAs in donor-derived HCV post-transplant is achievable and affordable; however, significant added administrative efforts may be required for insurance approval as well as obtaining copay assistance, which is a limited resource.