While a significant proportion of those seeking insurance coverage for hepatitis C virus (HCV) treatment may be initially denied, this decision may still be reversible upon appeal. Publishing their findings in PLOS ONE, researchers conducted a retrospective chart review of 174 individuals who were treated for hep C at the Yale Liver Center between October 11 and December 31, 2014.

A total of 129 of the people with hep C had their physicians request insurance approval for Harvoni (ledipasvir/sofosbuvir). Of this group, 100 (77.5 percent) received approval on the first try, while another 17 (13.9 percent) of the individuals’ treatment was approved through the appeals process.

Mathematical modeling suggested that having advanced fibrosis, having a high Model of End Liver Stage Disease (MELD) score, and being a woman were each independently associated with shorter times until the insurers issued a decision or approval. Having Medicaid or Medicare coverage and having a viral load of at least 6 million were linked with respective 5.96-fold and with 4.52-fold greater likelihoods of receiving an initial approval of Harvoni coverage.

To read the study, click here.