Second State Sued Over Hepatitis C Medication Access

Feb 19, 2016

Credit From the Annals of Internal Medicine article: Restrictions for Medicaid Reimbursement of Sofosbuvir for the Treatment of Hepatitis C Virus Infection in the United States / Authors: Soumitri Barua; Robert Greenwald, JD; Jason Grebely, PhD; Gregory J. Dore, MBBS, PhD; Tracy Swan; and Lynn E. Taylor, MD

Medicaid patients in Washington state (a similar suit is underway in Indiana) have sued the state's Medicaid agency claiming they were denied treatment for hepatitis C because of the high cost of the drugs. Litigation director Kevin Costello with the Harvard Center for Health Law and Policy Innovation says his organization has joined the lawsuit.

“We really view Washington as a first step in solving a problem in a much broader context," says Costello. "So it’s one small piece of a broader puzzle.”

The broader puzzle is a patchwork of state Medicaid policies about how sick patients must be before their treatment will be covered. Rhode Island’s Medicaid policy also requires patients with hepatitis C have a certain level of liver damage before they qualify for treatment. 

Currently, Washington Medicaid patients with hepatitis C must wait until they’ve developed cirrhosis of the liver to get the drugs. Costello says they shouldn’t have to wait.

“We stand in solid ground in arguing to a court that if you have a chronic inflammatory disease that is in the process of ravaging one of your vital organs,: says Costello, "the cure that exists is certain medically necessary for you to receive.”

Costello is referring to new direct-acting antiviral medications like Harvoni and Sovaldi which have reportedly high cure rates. A cure was hard to come by only a few years ago for this chronic infection which can lead to liver cancer.

Seattle’s Medicaid agency tells the Seattle Times that figuring out how to pay for the drugs when so many patients are infected is a challenge most Medicaid agencies are also dealing with. That includes Rhode Island and other New England states, which Kevin Costello says could be taken task for similar restrictions. 

Washington state’s Medicaid officials tell the Seattle Times they’re not alone in balancing the high cost of hepatitis C drugs with a large number of infected patients. That includes Rhode Island and other New England states, which Kevin Costello says could be taken task for similar restrictions. 

You can read the complaint filed in U.S. District Court in Washington here:

 

Harvard Center For Health Law and Policy Innovation Hepatitis C Complaint (PDF)
Harvard Center For Health Law and Policy Innovation Hepatitis C Complaint (Text)