Across the globe, people will mark World Hepatitis Day on July 28 to raise awareness about viral hepatitis, call for better access to prevention and treatment programs, and advocate for greater government action. Here in the United States that includes bringing to light the hundreds of thousands of people living with hepatitis C (HCV) who could be cured of their disease in as little as two months by a pill taken just once a day. However, most state Medicaid programs are refusing to pay for their treatment. Claiming high drug costs, these states are restricting access to only those with severe liver damage or who have abstained from substance use. This forces people to become sicker than necessary, violates current Medicaid law, and will cost state Medicaid programs more in the long run. This rationing of treatment needs to be stopped.
HCV is a deadly infectious disease. Left untreated, it can cause liver damage, cirrhosis, and is a leading cause of liver cancer. Every year, nearly 20,000 people in the United States die from HCV and its complications, and HCV-associated deaths now exceed the number of deaths from 60 other nationally notifiable diseases, including HIV, combined. More than one-third of the estimated 3.5 million people living with HCV in the United States are expected to die from HCV-related complications that could be averted by a simple treatment over a matter of weeks if they have access to the drugs. With the number of new HCV cases having tripled since 2010, an increase fueled by the opioid epidemic, something needs to be done now.
Instead, states are making it harder to access treatment. Currently, 33 states plus the District of Columbia are restricting access to the HCV cure to patients with a Fibrosis Score of F2 or higher, and 15 of those states require a score of F3 or above. Translated into layman’s terms, a score of F2 means moderate liver scarring while F3 means severe fibrosis. Additionally, 38 states require patients to attest to or be tested for sobriety from drugs and/or alcohol, or to be assessed or enrolled in a substance use treatment program, before HCV treatment can begin. These restrictions violate Medicaid law, is against what the FDA decided when they approved the drugs and run counter to current HCV treatment guidelines.