by Amanda Conschafter, blog editor
Just as new data shows hepatitis C deaths at an all-time high, New York state has taken a bold move to make curative treatments more available. The state had previously required its Medicaid recipients to wait until stage 3 liver fibrosis before receiving pricey direct-acting antiviral cures. New York has now eliminated those requirements.
According to Politico, the state’s decision may have resulted from advocacy organizations putting pressure on New York’s Drug Utilization Review Board. The policy director of a state nonprofit AIDS organization celebrated the decision, saying, “This is the breakthrough we’ve been waiting for.” Around the same time that the state Medicaid system opted to remove barriers to access, New York Attorney General Eric Schneiderman announced that seven private health insurers also would change their coverage for hepatitis C cures. New York has roughly 200,000 citizens with the disease.
Despite patients’ victory in New York, however, care rationing remains common among state Medicaid systems struggling to manage the expense of hepatitis C cures.
Nevertheless, research confirms that curing patients generates cost-savings in the long term despite upfront costs. A May 2016 special edition of the American Journal of Managed Care showed that expanding coverage to treat patients earlier in their disease could save the Medicare system $4-11 billion and private insurers $10-14 billion over a 20-year horizon. In the short term, however, access continues to be a point of contention. The Centers for Medicare and Medicaid Services issued a letter in November 2015 reminding state Medicaid systems of their responsibility to provide their recipients with necessary care. Some states have taken heed.
Meanwhile, several states have had to pursue or threaten legal action to persuade private insurers to expand coverage. The Alliance for Patient Access and the AIDS Institute recently submitted a letter to Florida’s insurance commissioner expressing concern about private insurers’ discriminatory coverage designs in the state.
The access issue is an increasingly important one. Newly released data from the Centers for Disease Control and Prevention show that hepatitis C deaths reached a record high in 2014. A second CDC study showed that hepatitis C mortality “surpassed the total combined number of deaths from 60 other infectious diseases.”
Hepatitis C affects more than 3 million Americans. The disease, chronic for many patients, can develop into cirrhosis of the liver or liver cancer.
