The last of dust along the high costs of drugs against hepatitis C, the ACLU is threatening Colorado officials to sue if they refuse to expand access to medicines in the state Medicaid program.
The saber rattling came in response to a longstanding policy by the state Medicaid program to restrict coverage only to people with the most advanced stages of liver disease such as cirrhosis.
“Basically, Colorado has been holding treating Medicaid beneficiaries until they have measurable damage to their livers. And we believe that the restrictions violate the Medicaid statute,” Mark Silverstein, ACLU legal director Colorado, STAT said. “We hope they will do the right thing, but we are prepared to pursue litigation otherwise.”
The article continues after the announcement
Drug Utilization Review Board of State met last night to review applications and to extend coverage decision is due in September 1.
Since 2013, the state has spent $ 26.6 million on treatment of 326 patients with hepatitis C, or about $ 82,000 per person, according to a spokesman of the State Department Policy healthcare and finance, which oversees the state Medicaid program. If the state were to cover all Medicaid patients with hepatitis C, regardless of the stage of their disease, it would cost $ 174 million . “It could be a budget problem,” he said.
the fighting comes amid increasing pressure on public and private payers to loosen restrictions on drug coverage for hepatitis C. These new types of treatments began arriving early 2014 and have very high cure rates, but they are also expensive, ranging in price from $ 54,600 to $ 94,500, depending on the dose and guidelines, although this is before applying rebates or discounts.
high cure rates led many doctors to prescribe medications – especially for drugs and Sovaldi Harvoni sold by Gilead Sciences. Drug manufacturers and their advocates have argued the short term disbursement saves money long term in the treatment of liver failure or liver cancer, and liver transplants.
Payers have complained that drug budgets are wound, and an increasing number of taxpayers have established restrictions on coverage. These movements, however, are becoming counterproductive. Last November, the Obama wrote state Medicaid programs that may be violating federal law restricting access to medicines for hepatitis C. And last May, a federal judge ordered Medicaid program to lift the restrictions on coverage of Washington state.
In April, seven commercial insurance companies reached agreement with the attorney general of New York to remove barriers to coverage. Health plans had to remove restrictions that require their members to have an advanced stage of the disease. And several commercial insurance companies in Washington state and California recently moderated coverage restrictions in response to lawsuits filed by consumers.