Original Research Article| Volume 223, ISSUE 5, P975-982, May 2022

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

Published:September 13, 2021DOI:


      • Although all patients were able to access HCV DAA therapy, 35% of patients required an insurance appeal process.
      • Median time from transplant to first dose was 45 days.
      • Prior authorization denials necessitating insurance appeals led to delays in therapy.
      • Patient cost was minimal after utilization of copay assistance programs, which are a limited resource.
      • Access to DAA therapy for solid-organ transplant patients may require added administrative efforts to complete the insurance approval process.



      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.


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