by Amanda Conschafter, blog editor
Expensive new therapies to cure hepatitis C are racking up big bills for Medicare and state Medicaid programs. But will cost concerns promote care rationing – limiting treatment to the fewest and sickest patients? And will budget discussions overshadow the legitimate medical need of patients who cannot access therapies to cure their worsening condition?
Individual states reveal startling trends for patient access. Illinois officials, for example, instituted one of the country’s most stringent prior authorization processes to limit spending on hepatitis C cures. Using a 25-requirement process to limit access, the state rejected all but the sickest patients – typically those with the most liver scarring. The state also rejected patients who had drug or alcohol abuse in their history. Only 208 patients received treatment through Illinois in 2014.
Texas took an even more restrictive stance. The state provided no Medicaid patients with the hepatitis C cure available in 2014, although Texas has the third largest Medicaid population in the country. Meanwhile, in California, Medicaid officials continue to receive complaints of “inappropriate denials” for patients whose physicians request a hepatitis C cure but are rejected by the private insurers managing Medicaid benefits.
Health care providers face mounting frustrations. As reported by the Wall Street Journal, one California physician reported that Medicaid rejected treatment for even her patients who were nearing decompensated cirrhosis, “the point at which most patients die unless they receive a liver transplant.” In the same news story, a professor of medicine noted that “We could literally end the hepatitis C epidemic if we put [new cures] to use.”
Patient advocates are likewise ruffled. The executive director of the National AIDS Treatment Advocacy Project complained to New York’s “Capital” that ““The payers are now controlling access to care, not the doctors, not the patients.”
Many states continue to consider whether to tighten restrictions or attempt to negotiate pricing for hepatitis C cures. Meanwhile, patients wait for the treatment they need but may not get – as their condition worsens.