Seven health insurers in New York are expanding their criteria for covering hepatitis C virus (HCV) medications under the terms of new agreements with State Attorney General Eric Schneiderman, The Wall Street Journal reports. The deals are part of an ongoing push by Schneiderman’s office to end discriminatory selection processes for HCV-positive people.
The agreements require the insurers to cover hep C medications for nearly all people who have commercial insurance plans in the state, regardless of their degree of liver damage. They also cannot deny treatment based on alcohol or drug use. Insurers included in the deal include Affinity Health Plan, Anthem Inc., HealthNow New York Inc., Independent Health Association Inc., UnitedHealth Group Inc. and MVP Health Care.
In exchange, Schneiderman’s office will end its official investigation into these health plans, which began last year with a barrage of warning letters and subpoenas for documents and claims data to all commercial health insurers in the state. The investigation has since shown a wide disparity in how insurance companies across the region have been covering new hep C treatments.
According to the report, most insurers cited in the agreement were approving hep C treatment only for people who already showed advanced liver damage. Five of the insurers denied 30 to 70 percent of all claims. The reason? The attorney general’s report showed that insurers’ anxieties over the high price of HCV treatment (which can cost up to $94,000 per patient for a standard 12-week therapy) drove the discriminatory policies.
The New York State Department of Health also reports that Medicaid insurers are updating their plans in consultation with the attorney general’s recommendations to reduce their restrictive policies as well.