State Governments Responding to Curative but Costly Hepatitis C Medications

Several states – including Delaware and Georgia – are beginning to take action to increase diagnosis and access to treatment for patients with hepatitis C. The news comes in the wake of several studies showing that patients are often denied treatment. In addition, a highly regarded health council recently asked the White House to remove the restrictions that Medicaid often places on costly treatments that effectively amount to a cure for the potentially deadly disease.

Several states — including Delaware and Georgia – are beginning to take action to increase diagnosis and access to treatment for patients with hepatitis C. The news comes in the wake of several studies showing that patients are often denied treatment. In addition, a highly regarded health council recently asked the White House to remove the restrictions that Medicaid often places on costly treatments that effectively amount to a cure for the potentially deadly disease.

The issue of coverage is an interesting twist on what should simply be a huge success story: a cure for a previously difficult to treat illness that impacts millions and costs hundreds of millions of dollars each year to treat. But striking the balance between providing the cure, contributing to public health, and yet using scarce public dollars to do so, has opened up a series of challenges.

Health officials estimate that about 3 million people in the United States and 150 million worldwide are infected with hepatitis C, which can go undetected for years while seriously damaging the liver. Delaware health officials are now aiming to better identify those who may be at risk, with a new campaign on hepatitis C screening for baby boomers and intravenous drug users that will launch in mid-October. The program will teach health care providers, particularly primary care doctors and substance abuse clinicians, about how the disease is transmitted and whom to screen.

The new program is essentially an acknowledgment that cases of the disease are substantially under-reported in Delaware, which is one of only seven states that doesn't consistently report case numbers to the Centers for Disease Control and Prevention (CDC). Screening won’t solve the issue of the cost of the medications, but it will help identify those who will seek that coverage. State officials recognize that they’ll need a comprehensive plan to address coverage, and they hope that getting a better handle on the size and scope of the infection in the State will help them get there.

In Georgia, the midyear 2016 fiscal budget and 2017 plans seek to expand care for costly hepatitis C drugs in the amount of $23 million per year. While Medicaid is jointly funded by the state and federal governments, it is managed by the states, which have broad leeway to determine benefit exclusions. The Georgia Medicaid program covers Gilead’s Sovaldi® and Harvoni®, as well as AbbVie’s Viekira Pak®, but with some restrictions. Harvoni is considered a “preferred” medication, but it requires prior authorization and that members who abuse alcohol or IV drugs must be enrolled in a substance abuse program. These provisions are less restrictive than those included in many states’ coverage plans, some of which only cover the medications for patients in the late stages of liver disease.

Sooner rather than later, many more states will have to examine their coverage policies and consider expanding screening and diagnosis programs. That presents an interesting dilemma as well; finding more people with hepatitis C has obvious individual and public health benefits — and obvious additional costs.