The long wait is over for Illinois Medicaid patients with hepatitis C. Last week, officials released new prior authorization criteria that eliminate advanced-stage liver fibrosis as a prerequisite for treatment. In other words, cures for the progressive disease will no longer be limited to only the sickest patients.
Illinois previously earned a D- for its restrictive Medicaid policies. Some doctors even called the state’s approach criminal. Direct-acting antivirals’ curative rate bests 90 percent, yet Illinois previously required a 17-step process for patients to access them. In addition to demonstrating advanced liver damage, Medicaid patients had to pass a sobriety test, prove mental competency, demonstrate that they had no organ malignancy or terminal illness, take a pregnancy test, and sign a treatment commitment letter. The state also limited which physicians could prescribe direct-acting antivirals.
Though prior authorization requirements are still in place, the newly released criteria do expand treatment to patients in the earlier stages of the disease and no longer require a sobriety test. Illinois amended its criteria following a meeting arranged by Alliance for Patient Access that included Medicaid officials, members from the Hepatitis Therapy Access Working Group and other leading physicians, who suggested policy changes to improve patient access.
Advocates have been calling for reforms for years, highlighting how rationing cures costs patients and jeopardizes public health. Once cost prohibitive, direct-acting antivirals have decreased in price by almost 70 percent in the last five years.
Treating hepatitis C before the disease progresses is an investment that benefits not just affected patients but also public health. And Illinois isn’t the only state to recognize this fact.
Ohio Medicaid also announced it will further expand access to direct-acting antivirals. Last year, Ohio decreased the fibrosis requirement from F4 to F2. The state now plans to remove the requirement related to patients’ level of liver damage altogether. Effective January 1, patients with a score of F0, indicating a lower level of liver damage, will become eligible for treatment.