Hepatitis C is one of the most prevalent viruses in the United States, impacting over 2.4 million people nationwide and an estimated 6,700 to 20,000 people in Hawaii. Hepatitis C is a leading cause of liver cancer, and our state has one of the highest rates of liver cancer in the United States. Despite the availability of lifesaving treatments, many island residents experience inequities and systemic barriers that frustrate their access to needed care.
The geography of Hawaii makes it difficult for many islanders to access basic medical care. Those who are not in Honolulu face difficulties accessing a primary care provider or specialist. Rural residents also have difficulty obtaining medications that require a specialty pharmacy to fill. Pair these inherent barriers with those that are rooted in the healthcare system, such as requirements to obtain an approved prior authorization for hepatitis C treatment and specialist consultation, and many residents living with hepatitis C are left with limited options to seek treatment.
Prior authorization can cause a significant delay in the time it takes for a person to receive treatment due to administrative requirements associated with the process, leading to fewer prescriptions being filled and fewer patients being treated. Access to medication based upon evidence-based treatment guidelines are also often rejected in the prior authorization process. Time-consuming appeals must be filed with the insurance carrier to obtain appropriate treatment. Prior authorization requirements, along with substance use and prescriber requirements, fail to further the health of our community.
The state of Hawaii should lift all prior authorization restrictions on hepatitis C treatment if our state is to help gain ground on the World Health Organization’s (WHO) goal to eliminate viral hepatitis by 2030. Last year, the federal Centers for Disease Control and Prevention (CDC) declared viral hepatitis a “winnable battle,” meaning that significant progress can be made in a relatively short period of time. Local advocates, including Hep Free Hawaii, are now working on a strategy to eliminate hepatitis C, and hepatitis A and B, by 2030.
A recent report, “Hepatitis C: State of Medicaid Access,” graded Hawaii’s Medicaid program a “D” in its hepatitis C treatment access abilities, in large part because of prior authorization and other prescription requirements. Meanwhile, 14 states across the country have removed prior authorization for hepatitis C treatment for most state Medicaid beneficiaries entirely, as the treatment access landscape has changed over the past several years.
Broader action beyond lifting Medicaid restrictions is needed if Hawaii is to meet WHO’s goal to eliminate hepatitis C as a public health threat by 2030. Additional resources should be dedicated to populations that account for a large percentage of those living with hepatitis C in our community, including people who use drugs and people who are unhoused.
The costs of non-treatment far exceed the costs of effective treatment, as the complications of non-treatment may include liver cancer care and death. Treatment should be available in settings where people already receive services, such as primary care offices, community clinics, syringe services programs, substance use treatment centers, and carceral facilities. Hawaii should also increase the number of primary care providers treating hepatitis C.
In July, the viral hepatitis community around the globe recognized World Hepatitis Day to raise awareness around the global burden of the virus. Mahalo to Gov. David Ige for issuing a proclamation in support of World Hepatitis Day. This year’s World Hepatitis Day theme was “Hepatitis Can’t Wait” — a fitting call to action that all healthcare stakeholders must heed.
We urge Hawaii policymakers to continue the important work of creating a Hawaii free of hepatitis C.
Christina Wang is a nurse practitioner in Honolulu specializing in infectious disease; Heather Lusk is executive director of Hawaii Health & Harm Reduction Center and co-director of Hep Free Hawaii.
