RI Medicaid To Revisit Hepatitis C Drug Access Policy

May 4, 2016

Sovaldi, one of the first antiretrovirals to come out for hepatitis C, costs about $1000 per pill.
Credit Gilead Sciences

Rhode Island Medicaid is revisiting its policy for determining who receives pricey hepatitis C drugs. Current policy limits who gets treated and when, but those restrictions could be loosened.

Most of the new hepatitis C medications on the market can cure patients of the disease in a matter of weeks. But they’re expensive –tens of thousands of dollars per course. So Rhode Island’s health insurance program for the poor has limited the treatment to people in advanced stages of hepatitis C. Other states took similar positions. But Medicaid head Anya Rader Wallack says the environment is changing.

"There’s been some changes in other states recently," says Wallack, "and so we are doing a refresh of our data and our assessment of what any relaxation of the policy would cost. And I can’t promise that we’re making a decision by any particular date but we are actively looking at that now.”

Wallack says they’ll have to determine what loosening the policy might cost, based on how many patients might step forward for treatment.

Hepatitis C can cause serious liver damage. Most people don’t know they have the virus. The Centers for Disease Control and Prevention just issued a statement saying hepatitis C kills more people than any other infectious disease in the U.S., as well as the fact that deaths are up 78% over the past decade.

Some doctors and patients have criticized Medicaid for restricting access to the drugs, saying patients shouldn’t have to wait until their livers are damaged to qualify for treatment.