Missouri approves Medicaid coverage for HCV, but 23 other states still restrict treatment

John Murphy, MDLinx | November 30, 2017

After a lawsuit from three individuals on Medicaid, the Missouri Department of Social Services changed its hepatitis C (HCV) treatment policy to allow all Medicaid recipients access to an 8-week regimen (12 weeks if necessary) of direct-acting antivirals (DAAs).

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Medicaid coverage for HCV treatment

More than half of state Medicaid programs deserve a grade of “D” or “F” because of their restrictions on HCV treatments, report says.

“Thousands of people will now have access to a cure for a serious, infectious disease. For these people and their families, the cure means an end to the worry of a future of liver disease and liver cancer, and an end to daily pain and fatigue that comes with hepatitis C,” said John Ammann, JD, the McDonnell Professor of Justice in American Society at Saint Louis University School of Law, St. Louis, MO, and one of the lawyers representing the individuals bringing the suit.

Before this policy change, the Missouri Medicaid program restricted treatment access only to recipients with severe liver damage (F3 or greater). Widespread treatment was deemed too costly.

“Originally a 12-week treatment with the early agents [pegylated interferon plus ribavirin] was quite expensive, approximately $93,000 wholesale acquisition cost,” according to a statement from MO HealthNet, the agency that oversees Missouri’s Medicaid program. “Because of the high cost of these agents, having clinical criteria in place for approval of these drugs was necessary. As more new DAAs were approved, competition has helped lower the costs of treatment.”

Many states still failing

The change in Missouri’s Medicaid policy on HCV treatment took effect November 1. On the same day, Medicaid programs in North Carolina and Vermont also lifted restrictions that required recipients to wait until they had significant liver damage to receive treatment.

But nearly half of all other states still have restrictions that severely limit Medicaid recipients from access to HCV treatment, according to a recent report, “Hepatitis C: The State of Medicaid Access.” Produced by the National Viral Hepatitis Roundtable and the Center for Health Law and Policy Innovation of Harvard Law School, the report was released in late October just before the Medicaid policies changed in Missouri, North Carolina, and Vermont.

The report concluded that more than half of state Medicaid programs deserve a grade of “D” or “F” because of their restrictions on HCV treatments. While five states earned an “A” (Alaska, Connecticut, Massachusetts, Nevada, and Washington) five other states received an “F” (Arkansas, Louisiana, Montana, Oregon, and South Dakota).

The report gave 21 states and Puerto Rico a “D.” Missouri and North Carolina—whose new policy changes hadn’t been included in the report—were among eight states and the District of Columbia to receive a “C.” Eleven states, including Vermont, earned a “B” grade.

“States with the best grades have taken steps to ensure widespread access to hepatitis C treatments. These states should serve as a model for those still rationing access to a hepatitis C cure based on outdated cost concerns, rules that stigmatize those living with hepatitis C, and non-medically indicated treatment criteria,” said Robert Greenwald, JD, clinical professor of law and the director of the Center for Health Law and Policy Innovation of Harvard Law School, Cambridge, MA.

Click here to read the report.

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