The price of treatment has dropped for everyone except the most vulnerable patients.
In an exciting development, Missouri Medicaid (MO HealthNet) recently lifted restrictions on treatment of chronic hepatitis C, which will enable many low-income Missourians to access curative treatment.
Hepatitis C can lead to severe liver disease, liver cancer and death, killing thousands of Americans each year. Hepatitis C is a blood-borne virus that can be transmitted through blood transfusion, occasionally through sexual contact, sharing needles, or in some cases from mothers to children at the time of childbirth. Others at increased risk of infection include health care workers and first responders who may encounter infected blood from needle-sticks.
The Centers for Disease Control and Prevention have indicated that nearly 19,000 people will die each year in the U.S. due to hepatitis C and related liver disease. Even before the disease progresses to advanced stages, hepatitis C can cause fatigue, joint pain, depression, skin rashes and sore muscles. The disease can also lead to additional complications, including lymphatic cancers (particularly non-Hodgkin’s lymphoma), kidney damage and immune-related diseases. Moreover, chronic liver disease due to hepatitis C is one of the leading causes of death for black Americans between the ages of 45 and 64.
Note: Way to go Vermont and those who fought hard to remove the restrictions!
Office of the Health Care Advocate and Coalition Continue Advocacy to Ensure Treatment for All
At its meeting on October 24, Vermont Medicaid’s Drug Utilization Review Board (DURB) voted to lift the liver damage restriction that currently prevents many Vermont Medicaid patients with hepatitis C from accessing life-saving treatment. Because of this change many more Vermonters on Medicaid who have the life-threatening disease will gain access to curative treatment. Vermont Legal Aid’s Office of the Health Care Advocate and a coalition of organizations have been advocating for this change since 2015. The coalition sent a letter to the DURB earlier this month asking the Board to remove all remaining restrictions on hepatitis C medications.
On Tuesday, the DURB voted to stop requiring people to wait until they have significant liver damage to be treated. Since February, Vermont Medicaid has required a fibrosis score of F2 (moderate liver damage) or higher to access treatment. Prior to February Medicaid required a fibrosis score of F3 (severe liver damage) or F4 (cirrhosis) to access treatment. Patients will still need to see a specialist in order to get treatment.
“We are very pleased that the DURB voted to lift the liver damage restriction on hepatitis C treatment, as is required by federal Medicaid law. Treatment of every patient with hepatitis C is the standard of care. There is no medical justification for denying treatment because the patient’s liver isn’t damaged enough,” said Mike Fisher, Vermont’s Chief Health Care Advocate.
Stat, the online health news site, deserves credit for the grim picture it painted of health care dysfunction in the nation’s heartland. Kentucky has been ravaged not only by opioid drug abuse, including record numbers of overdose deaths, it also is struggling with a stark, related rise in diseases. In particular, cases of Hepatitis C have skyrocketed by 364 percent in Kentucky and surrounding states. Infections are growing most among young, rural whites, and to the growing concern of public health officials, Kentucky is recording increasing numbers of cases in which pregnant moms are infecting their babies.
Hepatitis C, a viral infection that damages the liver and is a factor in 19,000 Americans’ death annually, can lurk in the body for long periods before becoming deadly. As many as 4 million Americans may carry it and not know it until their liver damage becomes severe. The virus (depicted in the illustration above) spreads among addicts of pain-killing medications because they too often progress from prescription pill-popping to shooting up other increasingly powerful opioids like fentanyl and heroin.
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.
A state board recommended Tuesday night that more needy Coloradans receive potentially curative treatments for hepatitis C.
But the board stopped short of recommending that the treatments — new drugs that have been shown to have a 90 percent cure rate — be extended to all Coloradans on Medicaid. And that means the American Civil Liberties Union may file a federal lawsuit against the state to force it to provide treatment to everyone.
“It’s not just the right thing to do,” Mark Silverstein, the legal director for the ACLU in Colorado said at Tuesday’s meeting. “It’s also what’s legally required.”
For years, Valerie Green just wasn’t feeling right. She was in a constant state of fatigue but couldn’t figure out what was going on. Neither could doctors. That was until a specialist ran a series of blood tests last year, and one came back positive forHepatitis C.
“I was fairly shocked because I wasn’t that knowledgeable about the disease. Everyone knows it’s not a good thing, it effects your liver,” Green recalled. “It was pretty scary.”
What happened next put Green in the middle of a controversial, and now shifting, landscape when it comes to coverage of Hepatitis C treatment. In Delaware, that’s meant experiencing some of the most restrictive rules in the country to, as of this summer, some of the most lenient.
It’s not until the final two stages of liver damage that needy Coloradans with the blood-borne hepatitis C virus get access to a life-saving drug with a 90-percent cure rate and an exorbitant price tag.
“You’ve got to be on death’s door before they will treat you,” said David Higginbotham, a Colorado Medicaid beneficiary who contracted the virus 35 years ago while working as a hospital surgical tech. He would take the 12-week medication “in a heartbeat” if the Colorado Medicaid department would cover it, but Higginbotham’s liver “score” is 1 out of 4, and the government insurance plan won’t pay for the medicine until liver scarring has progressed to a score of at least 3.
Now pressure for change is increasing against the state Department of Health Care Policy and Financing, which has restricted access to the breakthrough drug due to its cost. State officials say they must balance the public health issue with the taxpayer expense of paying the prescriptions of the more than 9,000 people with hepatitis C on the government insurance system.