California has revised its Medi-Cal eligibility rules to ease restrictions on hepatitis C virus (HCV) treatment in 2015. However, even with the relaxed guidelines state health officials say the majority of HCV-positive people receiving care under the state-funded program still aren’t able to access the lifesaving cures, KPCC reports.
When next-generation hepatitis C drugs were first introduced in late 2013, California’s Department of Health Care Services stated that Medi-Cal members needed to have severe liver scarring, or cirrhosis, to access the medications. Over the next year, the state apparently rejected almost two-thirds of HCV treatment requests from Medi-Cal beneficiaries, leading to public outcry across California.
The state revised its hepatitis C treatment policy in July 2015, expanding eligibility to HCV-positive people with light liver scarring, as well as people considered to be at “high risk” for spreading the virus, including active injection drug users and women trying to become pregnant. Since then, state data has shown that the number of Medi-Cal beneficiaries being denied the drugs has dropped, but almost half of these requests are still being turned down under the new rules.
What’s more, of the estimated 250,000 Medi-Cal beneficiaries with hepatitis C, only 6,460 received treatment between December 2013 and March 31, 2016. However, treating this relatively small group cost the state nearly $590 million.
California health officials argue that decisions over which patients recieve hepatitis C treatment have not been made based on cost, but rather “on medical necessity and prior physician authorization,” as well as input from the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA).
But several advocates say it’s time to open up treatment access to all patients with hepatitis C. They argue that new evidence has shown that chronic HCV—even in patients with limited liver damage—is linked to a higher likelihood of a wide array of health issues, including cardiovascular disease, kidney disease and type 2 diabetes.
The California Department of Health Care Services says the agency has no current plans to further revise its hepatitis C eligibility policy.