Report: State Medicaid Programs Illegally Restrict Access To Hep C Drugs

Nov 15, 2016

Hepatitis C attacks the liver. It's the leading cause of liver cancer.
Credit National Institute of Diabetes and Digestive and Kidney Diseases

State Medicaid programs – including Rhode Island – fail to provide enough access to cures for hepatitis C. That’s the conclusion of a new report from Harvard Law School’s Center for Health Law and Policy Innovation and the National Viral Hepatitis Roundtable. The authors say restricting treatment is illegal.

New hepatitis C medications are expensive. That’s why state Medicaid programs like Rhode Island’s restrict access. Patients must have a high level of liver damage. And be abstinent from drugs and alcohol (unless their physicians can attest they're in treatment). And only specialists can prescribe. All of that is illegal, says Robert Greenwald with the Center for Health Law and Policy Innovation at Harvard Law School.

“Medicaid programs have an obligation under the law to provide medically necessary care. And that cost alone cannot be a justification for access to care.”

Greenwald says states like Connecticut and Massachusetts have opened up access to hepatitis C drugs recently. Connecticut has no restrictions on the amount of liver damage to qualify for treatment. And Massachusetts does not require sobriety to be treated. 

“I certainly am hopeful that the state of Rhode Island can join some of the other New England states that are moving forward to address the number one communicable disease killer in this country.”

Greenwald says hepatitis C now kills more Americans that nearly 50 other communicable diseases combined, including HIV. He has sued other state Medicaid programs over access to hepatitis C drugs – and won.

The National Viral Hepatitis Roundtable receives funding from the Centers for Disease Control and Prevention and corporate supporters which include drug companies, diagnostic companies, and pharmacies. A spokeswoman for the organization says their research was independent and their methodology transparent.