{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T01:37:46Z","timestamp":1773884266570,"version":"3.50.1"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,9,3]],"date-time":"2020-09-03T00:00:00Z","timestamp":1599091200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The advent of direct\u2010acting antivirals (DAAs) has created an avenue for transplantation of hepatitis C virus (HCV)\u2010infected donors into uninfected recipients (D+\/R\u2212). The donor transmission of HCV is then countered by DAA administration during the post\u2010operative period. However, initiation of DAA treatment is ultimately dictated by insurance companies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective chart review of 52 D+\/R\u2212 kidney recipients who underwent DAA treatment post\u2010transplant was performed. Patients were grouped according to their prescription coverage plans, managed by either commercial or government pharmacy benefit managers (PBMs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010nine patients had government PBMs and 13 had commercial PBMs. Demographics were similar between the two groups. All patients developed HCV viremia, but cleared the virus after treatment with DAA. Patients with government PBMs were treated earlier compared to those with commercial PBMs (11\u00a0days vs 26\u00a0days, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.01). Longer time to DAA initiation resulted in higher peak viral loads (<jats:italic>\u03b2<\/jats:italic>\u00a0=\u00a00.39, <jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a0.15, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.01) and longer time to HCV viral load clearance (<jats:italic>\u03b2<\/jats:italic>\u00a0=\u00a00.41, <jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a0.17, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>D+\/R\u2212 transplantation offers patients an alternative strategy to increase access. However, treatment can be profoundly delayed by a third\u2010party payer authorization process that may be subjecting patients to unnecessary risks and worsened outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tid.13449","type":"journal-article","created":{"date-parts":[[2020,8,28]],"date-time":"2020-08-28T07:11:36Z","timestamp":1598598696000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Commercial insurance delays direct\u2010acting antiviral treatment for hepatitis C kidney transplantation into uninfected recipients"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8270-2230","authenticated-orcid":false,"given":"Julia","family":"Torabi","sequence":"first","affiliation":[{"name":"Albert Einstein College of Medicine Bronx NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan P.","family":"Rocca","sequence":"additional","affiliation":[{"name":"Albert 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