Massachusetts is the latest state to lift restrictions on hepatitis C virus (HCV) treatment under its Medicaid program, joining a wide array of states and health insurance companies across the country that have been opening up access to the lifesaving cures over the last year. Thanks to legal battles and lobbying efforts, experts say “the writing is on the wall” for restrictive policies surrounding HCV treatment, USA Today reports.
Massachusetts’s big expansion follows a recently threatened lawsuit by the state’s attorney general against HCV drugmakers Gilead Sciences, AbbVie and Merck, which ultimately induced the pharmaceutical companies to offer the state bigger rebates on the $1,000-per-pill cures, rendering them more affordable. Now, Massachusetts says it can afford to treat all its hepatitis C-positive beneficiaries, not just those with advanced liver disease.
Over the last few months, Florida, New York, Washington state and Delaware have made similar moves to expand access to hepatitis C treatment in their Medicaid programs. Commercial insurers such as Anthem Inc. and United HealthCare have done the same. Many have done so under the threat of legal action and political pressure from hepatitis advocates across the country. It’s a promising trend that experts believe will begin to take hold across the United States, as plaintiffs continue to win their cases against restrictive health care policies.
However, in many of the states that have decided to ease their hepatitis C treatment restrictions, pricing remains a problem. With new HCV drugs costing between $54,600 to $94,500 per patient for a standard 12-week treatment, many states are scrambling to set aside big enough budgets to keep up with patient demand. However, advocates have long argued that the huge up-front cost of HCV treatment for all is likely to save insurers millions of dollars in long-term care.
Nationwide, an estimated 3.5 million Americans are thought to be living with a chronic hepatitis C infection. Of those, 1 million people have their health care covered under Medicaid. By law, the state-funded programs are required to cover medically necessary treatments, regardless of cost considerations. In light of this recent momentum to open up HCV treatment access, legal advocates say they hope to achieve a “50-state solution” for those seeking a cure over the next few years.