Recent data released by Trio Health show that the prevalence of hepatitis C drug patients diagnosed with Hepatitis C but not started on curative drugs, such as Harvoni (ledipasvir/sofosbuvir; Gilead) and Zepatier (elbasvir/grazoprevir; Merck), more than tripled between 2014 and 2016—signaling that payers continue to deny coverage despite increased marketplace competition and availability of discounts.
“There are no other disease states that I’m aware of where curative therapies are increasingly withheld from patients who are covered by commercial insurance plans, Medicaid or Medicare,” Nezam Afdhal, MD, professor of medicine, Harvard University, and chairman of Trio Health’s Scientific Steering Committee, said in a press release.
According to the data, although the number of treated patients continually decreases, the total number of patients seeking treatment for their condition continues to grow each year. On average, as of last September, 37% of patients who showed little-to-moderate traces of the disease were denied—a steady increase from 27% in October 2015. Likewise, 24% of those with advanced forms of hepatitis C were also denied—an increase from 15% during 2015. Overall, non-starts increased from 8% in 2014 to over 30% in 2016.
Nothing about a Washington state lawsuit called B.E. v. Teeter is as simple as it seems.
It was filed this year by two hepatitis C patients against the state’s Medicaid program to help the poor gain access to drugs such as Gilead Sciences Inc.’s $1,000-a-pill cure.
But behind the team bringing the case is Gilead itself. While the drug giant isn’t involved in the lawsuit, the company and its foundation have donated hundreds of thousands of dollars to the researchers, lawyers, patient advocates and medical expert who have helped build the case.
Seven health-insurance companies in New York will change their criteria for covering costly drugs that cure chronic hepatitis C under the terms of agreements with the office of State Attorney General Eric Schneiderman.
The agreements, expected to be announced Tuesday, require the insurers to cover hepatitis C medications for nearly all patients who have commercial insurance plans in the state.
Last year, Mr. Schneiderman’s office began an investigation into coverage of drugs for chronic hepatitis C, issuing subpoenas for documents and claims data to all commercial health insurers in the state. The investigation showed a wide discrepancy in how companies cover these drugs and found some insurers largely covered only patients with advanced stages of the disease, the attorney general’s office said.
Sarah Jackson knows she has hepatitis C, a disease that if left untreated could leave her with lasting damage to her liver. She also knows a drug exists that could cure her condition before it progresses further.
But Jackson relies on the state for her health insurance, treatment with this drug can cost thousands of dollars, and Indiana, like most other states, refuses to pay for the drug for her or any other Medicaid recipient until they have entered a later stage of the disease.
The American Civil Liberties Union of Indiana recently sued Indiana’s Family and Social Services Administration on behalf of Jackson and others like her, asking the state to reverse its policy and provide at least some of these expensive drugs now.