Medicaid rules limit treatment of hepatitis C in rural Indiana town facing HIV epidemic

The lone doctor in the rural Indiana town of Austin (Best Places map) that has faced an HIV outbreak is unable to "prescribe the latest treatments for patients also infected with the deadly Hepatitis C virus," Maureen Hayden reports for Community Newspaper Holdings Inc. While Dr. William Cooke is treating dozens of people with HIV, "state Medicaid rules forbid him from prescribing new treatments to those same patients with Hepatitis C, the blood-borne disease that causes inflammation in the liver and now claims more lives than HIV in the U.S."

"The rules put tight limits on treatments paid for with taxpayer dollars," Hayden writes. "The only doctors who can prescribe the expensive drugs are gastroenterologists and infectious disease specialists. But neither exist in the poor rural communities of Scott County—nor in many other rural areas throughout where cases of Hepatitis C are on the rise."

Even though Cooke said most Hepatitis C treatments can be delivered in a family doctor’s office or clinic, "a gastroenterologist specialist from New Albany, 30 miles away, visits patients at the county’s only hospital, in Scottsburg, twice a month," Hayden writes. Cooke told her, "Some of my patients can’t or won’t go. We had a hard enough time getting people tested for HIV. They don’t trust doctors to begin with, and they don’t trust strangers.”

Medicaid officials "say the rules were written with the input of a state panel of medical experts and are meant to safeguard patients who are chronically ill and need the care of specialists," Hayden writes. "Indiana is one of at least 14 states with Medicaid programs that require Hepatitis C treatment to be overseen by a specialist, according to a study by infectious disease experts that was published in the Annals of Internal Medicine." (Read more)