National Policy Office – Washington, DC: 202-835-8373
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For Immediate Release: 11.05.15
Media Contact: Carl Schmid: (202) 669-8267 firstname.lastname@example.org
Urges State Medicaid Programs to Lift Restrictions for the Nation’s Most Vulnerable
Washington, DC – The AIDS Institute praises the Obama Administration for their letter sent today to State Medicaid Directors that suggests states lift their onerous restrictions that have prevented people living with hepatitis C access to medications that can cure them. “Denying drugs that can cure people of a deadly infectious disease is just bad public health policy. This announcement demonstrates that Medicaid beneficiaries with hepatitis C, who represent some of the Nation’s most vulnerable, deserve access to a cost-effective cure just like anyone else,” commented Carl Schmid, Deputy Executive Director of The AIDS Institute.
The AIDS Institute, a national public policy and advocacy organization dedicated to ensuring people living with HIV and hepatitis have access to quality and affordable health care, along with others, have urged the Centers for Medicare and Medicaid Services (CMS) to take this corrective action. Most state Medicaid programs have instituted barriers to accessing hepatitis C cure drugs by limiting them to only individuals with advanced liver disease. States have also used a number of other restrictions which have no scientific basis such as limits on who can obtain and prescribe the drugs. In one recent study, 46 percent of Medicaid beneficiaries were denied access to hepatitis C drugs.
Medicaid is a joint federal-state funded program. States must cover all medications produced by pharmaceutical manufactures that participate in the Medicaid Drug Rebate Program. While states may be putting the hepatitis C drugs on their formularies, many are making it extremely difficult for patients in need of the drugs to access them. Today’s announcement makes it clear that this is wrong and states need to remove restrictions that have no clinical or scientific basis.
Nationwide, an estimated 3.2 million people are living with hepatitis C; however, up to 75 percent have not yet been diagnosed. There are approximately 20,000 deaths attributed to hepatitis C annually in the U.S. and it is the leading cause of costly liver cancer and liver transplants.
Clinical experts at the American Association for the Study for Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) have recently updated their guidance on the treatment of hepatitis C virus. They have concluded that treatment would benefit nearly all of those who are chronically infected and the goal should be to treat all patients as promptly as feasible to improve their health and to reduce HCV transmission.
Since many Medicaid beneficiaries are now being served by Medicaid Managed Care Organizations (MCOs), the directive announced today makes it clear that MCOs cannot impose restrictions on patient access that are more restrictive than the state’s fee-for-service program. In some states, Medicaid MCOs have instituted even far wider restrictions than the state run programs.
“Now, we call on all state Medicaid programs to remove patient barriers to hepatitis C treatment that the federal government has called to be eliminated,” said Michael Ruppal, Executive Director of The AIDS Institute. “In the long run, it will save the health care system billions of dollars, save the lives of hundreds of thousands of people, and help eradicate a deadly infectious disease.”
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Deputy Executive Director
The AIDS Institute