Medicaid & commercial payers forgo restrictions on costly hepatitis C medications: 7 notes

Various states and commercial insurers, including United HealthCare and Anthem, have started lifting bans on expensive hepatitis C treatment so thousands of Americans can obtain access, according to Kaiser Health News.

Here are seven notes:

1. Massachusetts recently imposed a rule stating any individual with hepatitis C covered through the state's Medicaid program will be eligible for the latest generation of anti-viral drugs. Prior to the ruling, Medicaid managed care plans limited the drugs, only allowing people with advanced liver disease to obtain drugs with a price of $1,000 or more per pill.

2. The state imposed the ruling after the Massachusetts's attorney general threatened a lawsuit against pharmaceutical companies. The potential lawsuit caused such companies to offer the state larger rebates on hepatitis C drugs, which made the treatments less costly.

3. Nearly two months ago, a federal judge ruled the state of Washington had to provide Medicaid members with hepatitis C treatment even if patients did not exhibit serious medical complications from the disease at that point in time.

4. While more Americans are obtaining affordable medications, many states have to devise a solution to offset the ensuing expenses from covering thousands of new patients. Matt Salo, executive director of the National Association of Medicaid Directors, said, "We want to give these medications to everybody who needs them, but with the prices they're commanding, something has to give. We've run out of escape valves."

5. Before states lifted the ban, they only provided drugs such as Sovaldi, Harvoni, Viekira Pak and Zepatier to patients with serious medical conditions resulting from hepatitis C. While the drugs got rid of hepatitis C more than 90 percent of the time, the drugs carried a price tag between $54,600 and $94,500 for an average 12-week treatment course.

6. Anthem Blue Cross and Blue Shield implemented a policy which permitted people of fibrosis stages to obtain treatment. Before the policy, Anthem BCBS limited the treatment to patients with severe fibrosis or cirrhosis.

7. In March, the VA reported it would treat any individual in its system with hepatitis C treatment, no matter the stage of illness.

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