Colorado is latest state to be sued for restricting access to hepatitis C drugs

www.statnews.com/pharmalot/2016/09/22/colorado-sued-for-restricting-hepatitis-c-medicine/

The DEA/CDC/FDA/Surgeon General and others can limit/restrict the medically necessary pain medication for the estimated 116 million chronic pain pts.. and where is the ACLU… AWOL ???  You have Hep C and you die because of liver failure.. because Medicaid won’t pay for the appropriate medication.. that is a bad thing… Chronic pain pts have their medication denied or limited by insurance and some commit suicide or die from hypertensive crisis or other related health issues from lack of appropriate pain management…  And the ACLU just turns a BLIND EYE ?

You can add Colorado to the list of states being sued for refusing to widen access to the hepatitis C medications in its state Medicaid program.

The lawsuit, which is seeking class action status, was filed on behalf of two Colorado citizens on Monday in response to a longstanding policy by the state Medicaid program to restrict coverage only to people with the most advanced stages of liver disease, such as cirrhosis.

The state “illegally restricts” access to medically necessary treatment “that can be provided only by” the available hepatitis C drugs, the lawsuit states. The state also “violates” standard medical care and “flaunts the clear instructions and warnings” of federal officials. The suit was filed by the American Civil Liberties Union and the Center for Health Law and Policy Innovation at Harvard Law School.

The lawsuit comes amid increasing pressure on public and private payers to loosen coverage restrictions on the hepatitis C medicines. These new types of treatments began arriving in early 2014 and boast very high cure rates, but are also costly, ranging in price from $54,600 to $94,500, depending upon doses and regimen, although this is before rebates or discounts are applied.

High cure rates prompted many physicians to write prescriptions — notably, for the Sovaldi and Harvoni drugs sold by Gilead Sciences. Drug makers and their supporters have argued the near-term spending saves money down the road on treating liver failure or liver cancer, and on liver transplants. But payers have complained the medicines are straining their budgets, and some instituted coverage restrictions.

Since 2013, the Colorado Medicaid program spent $26.6 million treating 326 hepatitis C patients, or about $82,000 per person, according to the state Department of Health Care Policy and Financing, which oversees the program. Last month, a department spokesman told us that if the state were to cover every eligible Medicaid patient with hepatitis C, it would cost $237 million.

State restrictions are under fire, though. Last November, the Obama administration wrote state Medicaid programs they may be violating federal law by restricting access to hepatitis C medicines. And last May, a federal court judge ordered the Washington state Medicaid program to lift coverage restrictions.

After the American Civil Liberties Union last month threatened to sue Colorado officials, the state Department of Health Care Policy and Financing loosened restrictions so that more people would be eligible for coverage under the Medicaid program.

The state determined that more patients would be covered for the drugs depending on the severity of their disease. Now, up to 70 percent of roughly 14,450 people who are diagnosed with chronic hepatitis C are eligible, a department spokesman told us.

However, the lawsuit contends the move did not go far enough and argued there should be no restrictions. The lawsuit argues the medicines do not reverse the disease, so treatment should be provided sooner rather than later; the disease can progress quickly in some patients, suggesting treatment should not be delayed; and common testing methods do not always produce accurate results.

A spokesman for the state Department of Health Care Policy and Financing declined to comment specifically about the lawsuit

 

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