The Wait Continues for Medicaid Patients with Hepatitis C

November 29, 2016

Despite being cautioned last year by the Centers for Medicare and Medicaid Services, many states still block patients with hepatitis C from receiving curative treatment. So reports a new study from Harvard Law School’s Center for Health Law and Policy Innovation.

Granted, the news isn’t all bad. More states now publicly disclose their criteria for accessing hepatitis C cures. And the number of states requiring prerequisites to treatment such as advanced liver fibrosis has dropped since 2014.

But restrictions remain. Only seven states have lifted the requirement that patients prove sobriety to access treatment, while four others actually tightened or “clarified” their restrictions. Likewise, only seven states relaxed requirements that the prescribing physician must be a specialist. Two states moved in the opposite direction to tighten those requirements.

Restrictions like these prompted the Centers for Medicare and Medicaid Services to issue a notice to the states in November 2015. The document reminds states of their legal obligation to provide Medicaid patients with “effective, clinically appropriate and medically necessary” treatments. Some states, such as Connecticut and Massachusetts, have taken incremental steps to expand treatment to as many patients as possible. Others, such as Kentucky, continue to struggle.

[WATCH: Rationing Hepatitis C Cures is Costing Patients]

In response to persistent access challenges, the report explains that, “We must hold federal and state insurance regulators accountable.” Some patients have done just that. Access barriers have given rise to legal challenges in several states, most recently Missouri. Patients in Colorado, Washington, Indiana, Massachusetts, Minnesota and Pennsylvania filed suit previously.

Meanwhile, state Medicaid officials still cite cost as their rationale for limiting treatment, even though the price – and the prescribing – of the drugs has decreased. But as Harvard’s Robert Greenwald explains, “cost alone cannot be a justification for [blocking] access to care.”

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