In 2015, federal health officials warned states to start expanding access to hepatitis C virus (HCV) treatment after finding that many could be breaking the law by withholding lifesaving medications to people in need.
Four years later, Stat News reports that findings from the latest update of the National Viral Hepatitis Roundtable (NVHR) and the Center for Health Law and Policy Innovation (CHLPI) at Harvard Law School’s “Hepatitis C: State of Medicaid Access” report show that many states still impose restrictions. And while some progress has been made over the past year, the fight for universal HCV treatment access is far from over.
According to the report, between November 2018 and July 2019, just six states have either removed or eliminated hepatitis C treatment restrictions based on patients’ degree of liver damage—one of the most common reasons today for denial of treatment. Just one state loosened rules requiring patients to be sober for a period of time before starting treatment. In addition, six other states loosened prescribing restrictions for health care providers.
Among the states that most restrict hepatitis C treatment are Alabama, Arkansas, Minnesota, Mississippi, Montana, Puerto Rico, South Dakota and Texas.
Among the states with the fewest Medicaid restrictions are Alaska, California, Colorado, Connecticut, Delaware, Idaho, Louisiana, Maine and Massachusetts. In addition, Missouri, Nevada, New Jersey, New Mexico, New York, Oregon, Pennsylvania, Rhode Island, Vermont and Washington have significantly opened up access to treatment over the past four years.
Many states cite the high price of hepatitis C treatment for imposing restrictions. State Medicaid programs have long argued that they must prioritize treatment for the sickest patients first as well as those most likely to successfully complete the standard eight- to 12-week course of treatment.
However, advocates and many medical providers say that requiring patients to reach a certain stage of fibrosis, or liver scarring, before they can access a cure puts them at unnecessary risk for liver disease and cancer. Meanwhile, sobriety requirements can keep patients with a history of alcohol or substance use disorders away from cures despite the fact that they are among those at greatest risk for illness and infection. What’s more, allowing only certain specialists, who can be difficult to find, to prescribe a cure could be unnecessarily limiting access to treatment.
It’s also important to note that HCV prescription restrictions go against current guidance from the Centers for Medicare and Medicaid Services, the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America.
To see how your state ranks in terms of hepatitis C treatment access, click here.