OBJECTIVES

Despite the availability of effective treatments for HCV and HIV, persistent barriers have compromised achievement of patient health goals, including those related to misalignment in policies and practices among treatment decision-makers. This research is aimed at developing a conceptual model of HCV, HIV, or HCV-HIV co-infection therapy decision-making based on prescriber and managed care perspectives, by qualitatively assessing and describing (1) prescriber and managed care considerations for treatment access, treatment differentiation, and patient selection criteria, and (2) barriers to therapy prior-authorization (PA) processes and communication.

METHODS

Qualitative data were collected through trained scribes during 25 accredited education seminars held in 25 US cities, May—November 2017, combining prescriber and managed care professionals who manage patients with HCV and HIV. The discussion texts were analyzed using thematic analysis to generate a conceptual model of interprofessional practice and communication on therapy decision-making.

RESULTS

Session data were collected from 270 prescribers and 211 managed care participants (combined sample: 44% pharmacists, 28% physicians, 29% NP/PAs). Findings revealed dominant themes: barriers were identified by both prescribers and managed care related to PA requirements, denials, and application of guidelines within therapy decisions. Specific forms of collaborative communication and practices were identified as aligned across both prescribers and managed care as mechanisms to close decision-making gaps: review guidelines and approval criteria, increase interprofessional communication, improve documentation and develop new protocols for PA submissions.

CONCLUSIONS

This research suggests that a conceptual model of prescriber and managed care barriers to optimal care of patients with HCV, HIV, and co-infection includes interprofessional alignment on domains that warrant improvement, and discordance in role-specific considerations for decision-making. The findings support the importance of considering the conceptual alignments when developing practical strategies for improved communication among prescribers and managed care decision-makers. Research was supported through education grants from AbbVie and Gilead.