Health advocates in Vermont are challenging a state Medicaid policy that restricts hepatitis C virus (HCV) treatment only to patients with advanced liver disease. The lawsuit is the latest in a long line of cases that aim to open up treatment access for next-generation hepatitis C cures for patients across the country, Vermont Public Radio reports.
Vermont Legal Aid, a nonprofit law firm that represents low-income clients, recently took up the cause of several people living with hepatitis C to appeal the state’s decision to deny them medication. Specifically, legal advocates are targeting Vermont Medicaid’s current prior authorization policy, which states that beneficiaries cannot receive treatment until they have reached a Metavir liver fibrosis of F3 or higher—at which point they have already sustained significant liver damage. The group is also trying to get the state to change other conditions of its hepatitis C treatment policy, including one that requires patients to see a specialist and another that requires patients to remain drug- and alcohol-free for six months before receiving a cure.
Current guidelines from the American Association for the Study of Liver Diseases (AASLD) and the Infectious Disease Society of America (IDSA) recommend doling out the cures for nearly all hepatitis C patients, regardless of how sick they are. The groups note that hepatitis C is linked to other serious health risks, such as inflammation, a higher risk of kidney disease and the development of diabetes. However, with HCV treatment costing between $54,600 and $94,500 per patient, 16 states across the country, including Vermont, continue to ignore these recommendations and limit treatment in order to avoid the financial burden.
The Vermont Drug Utilization Review Board is meeting next week to consider changes to its hepatitis C treatment guidelines. While Vermont state health officials say they’re open to changing the Medicaid policy, they’re also worried that offering hepatitis C cures to all low-income people who have it in the state could cost taxpayers as much as $25 million over the next two years.
Hepatitis advocates are also noting that whether or not to open up hepatitis C treatment access across the state will ultimately be the decision of the incoming administration of Vermont Governor-elect Phil Scott. They are hoping to use the upcoming review to push strongly for a rule change.