Access to Hepatitis C Treatment Expanded Among States, Private Insurers

Many states and private insurers are lifting the restrictions on patient access to expensive hepatitis C virus (HCV) drugs likely due to fear of legal actions.

The US Center for Medicare and Medicaid Services (CMS) recently announced that Massachusetts will remove access restrictions for Medicaid beneficiaries, according to a press release. Kaiser Health News reported this expansion is because the Massachusetts attorney general threatened to bring a lawsuit against drug manufacturers, convincing them to offer larger rebates to the state.

Other states such as Florida, New York, Delaware, and Washington have also chosen to expand patient access to treatment.

“We want to give these medications to everybody who needs them, but with the prices they’re commanding, something has to give,” said Matt Salo, executive director of the National Association of Medicaid Directors. “We’ve run out of escape valves.”

Private insurers such as Anthem Blue Cross and Blue Shield have been authorizing treatment for patients in any stage of fibrosis across 14 states since December, according to Kaiser Health News. UnitedHealthcare has also expanded their treatment coverage.

Thus far, there are 7 private insurers who have expanded treatment to patients yet to develop liver disease. The Department of Veterans Affairs and Medicare also both expanded their HCV treatment coverage.

However, states worry about the influx of patients who may now be able to receive treatment, which will initially drive up costs. But with new competitors entering the market, the prices of HCV drugs are likely to decrease and discounts could make the medications cost even less.

For example, Massachusetts recently negotiated lower pricing with Gilead and Bristol-Meyers Squibb, who each manufacture HCV drugs. The long-term savings and health benefits could potentially outweigh the initial surge of expenses, according to a study published by Value in Health.

It is possible that other states will follow suit and start providing much needed treatment to a vast majority of patients.