Controversial Medicaid restrictions are being pulled back in Colorado. Now, patients seeking treatment for Hepatitis C will no longer have to be in an advanced state of liver failure to have access to certain drugs and procedures. The move comes after a lawsuit called into question the state’s practice of only providing meds to the sickest of patients.
Stat News says Colorado was facing a lawsuit from the American Civil Liberties Union and Center for Health Law and Policy Innovation at Harvard Law. The lawsuit alleges the state’s Medicaid program only gave medicine to people with the most advanced stages of liver disease. The state was also accused of violating standard medical care and disregarding federal warnings.
Kevin Costello, the litigation director at CHLPI said in a statement mentioned in the article, “Were a cure for cancer … discovered, no one would tolerate insurance providers telling patients: ‘We need to wait until you get really sick before we treat you.’ But that’s what patients in Colorado with Hepatitis C were being told, and what patients in other states are still being told.”
The easement of restrictions will not automatically terminate the lawsuit, according to the publication, but an attorney for the ACLU says it’s a step in the right direction. The suit is still expected to make its way through the court system.
Stat News reports that Colorado state officials say that the drugs to treat Hepatitis C have gotten less expensive over the years and new drug companies have come out with quicker and more cost-effective treatment options. Dr. Judy Zerzan, the chief medical officer at the Colorado Department of Health Care Policy and Financing is quoted in the article as saying, “Over the past two years, there are more choices among these drugs, which has driven their cost down substantially.”
The article notes that a “new generation” of Hepatitis C medicines are very effective, with cure rates exceeding 90 percent. Because of the success rate, many doctors were writing prescriptions for the pricey medical option, despite the cost. The drugs were first made available in 2014, but the price has come down since then and many argued that spending Medicaid dollars on preventing liver failure would ultimately save on treatment costs down the road.
However, when the expensive drugs were being prescribed, Stat News says, many Medicaid programs took another approach. They instituted coverage restrictions, even in the face of warnings that the restrictions might be unlawful.
The American Association for The Study for Liver Diseases and The Infectious Diseases Society of America also issued guidelines that recommended doctors “treat all patients as promptly as feasible.” However, they noted that physicians may have to take into account the “cost of the Hepatitis C medicines when deciding whom to treat first.”
Stat News says, state Medicaid programs are improving their disclosure about access to Hepatitis C medicines and many have eased their restrictions. However, nearly one in four states still require patients to have advanced liver disease before treatment.
Jeffrey A. Newman represents whistleblowers: 1-800-682-7157