Monday, October 01, 2018

Courts make states provide expensive hepatitis C treatment

Recent court rulings and settlements in Indiana, Florida, Massachusetts, and Colorado, among others, have found that states can't withhold expensive but potentially life-saving medications from Medicaid beneficiaries and prison inmates with chronic hepatitis C, a liver disease that infects millions who don't know they have it.

"Hepatitis C kills far more Americans than any other infectious disease. But when new antiviral drugs that for the first time promised a cure for hepatitis C hit the market in 2014, states blanched at their eye-popping prices and took steps to sharply limit the availability of those treatments for Medicaid beneficiaries and inmates. According to one recent survey, only 3 percent of inmates in state penitentiaries with hepatitis C receive the cure," Michael Ollove reports for Stateline. "The antiviral drugs have since become cheaper, but judicial decisions and settlements have consistently found that states cannot deny treatment because of cost in any case."

Kentucky, which has the highest rate of new infections of hep C, spent $83,673 per case in the 2015-16 fiscal year. Since then, the cost of treatment has fallen. Colorado expected to pay $56,000 per case for treating prisoners, but is paying "significantly less," Kellie Wasko, deputy executive director at the Colorado Department of Corrections, told Stateline.

"Other experts say that with discounts, Medicaid and corrections systems can now pay as little as $10,000," Ollove reports. Greenwald told him, “Even at those prices, states are waiting for us to litigate before they’ll remove these restrictions. And the only explanation for that is the stigma.”

Hep C is often spread by opioid users sharing needles or engaging in risky sex while under the influence. Appalachian counties are some of the most vulnerable to the infection in the U.S., but fear of stigma keeps people from seeking testing or treatment.

"While providing the treatments will cost states tens of millions of dollars, health-policy experts insist the spending will provide an overall economic and public health benefit," Ollove reports. "Attacking hepatitis C in prisoners and in Medicaid patients, they say, will go a long way toward eradicating the disease while also saving money by preventing patients with untreated hepatitis C from progressing to liver failure and cancer."

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