It was a welcome shock. On November 5th, the Centers for Medicare and Medicaid Services (CMS) sent letters to the CEOs of several drug manufacturers about providing access to therapy for hepatitis C patients, telling them to assist states with making high-price drugs affordable. CMS also sent notices to state Medicaid programs reminding them of their obligation to provide access to medications.

Simultaneously, CMS issued a strong statement affirming the agency’s commitment to provide prescription drugs, specifically naming Medicaid recipients who have hepatitis C. Writing on the CMS blog, Andy Slavitt (Acting Administrator) wrote, 

“In order to have the maximum impact, medications must also be affordable and accessible. This is an important issue for Americans and for patients, businesses, and governments. Surveys suggest that as many as 25 percent of Americans cannot afford and, therefore, do not fill the prescriptions on which they depend...The rhetoric around health care costs can become heated, particularly around the cost of prescription drugs. At times, it can appear as if some of those who produce the pharmaceuticals and those whose lives often depend on them have unaligned interests...A recent example of a much discussed, highly-effective drug is a therapy used by Hepatitis C patients...”

In the CMS statement, states are reminded of their obligation, under the terms of the Social Security Act, that Medicaid programs must cover prescription drugs for medically accepted indications if the manufacturer of the drug is a manufacturer with whom they have rebate agreements. CMS encouraged states to ensure that their policies do not unreasonably restrict coverage of effective treatment.

The implications of this are enormous. Although these letters and notices targeted programs under CMS’s umbrella, it will be hard for the insurance industry to continue their restrictive practices. Last week I wrote about updates by the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) to the HCV guidelines. These strongly-worded updates coupled with CMS’s actions, indicate that the winds of change are blowing. It’s just a matter of time before access to hep C treatment in the U.S. will be expanded.

P.S. I spend a lot of time complaining, and now it is time to do some thanking. Please join me in showing appreciation for Andy Slavitt and CMS by “liking” his blog and tweeting a thank you to @ASlavitt @CMSGov