A group of Medicaid enrollees is accusing a Texas agency of rationing hepatitis C medicines due to cost, the latest such allegation in an ongoing battle between state officials and patients over access to the life-saving treatments.
In a lawsuit, the Medicaid beneficiaries allege the Texas Health & Human Services Commission restricts coverage of hepatitis C medicines to only those enrollees with severe liver damage, even though the drugs have cure rates approaching 100% for all infected people. As a result, they must wait until they have advanced liver disease or cirrhosis of the liver before being eligible for coverage.
For this reason, the beneficiaries claim the policy is discriminatory and violates federal law, because hepatitis C patients are encountering rationing in a way that no other chronically ill Medicaid beneficiaries in Texas are facing. The lawsuit also noted the policy runs counter to guidelines issued by the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America.
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I wish that negotiations could take place. Treatment for hepatitis C should be available for everyone. That is the way to prevent spread of the virus. But when only 1/5 of hep C carriers can get it, that does not stop dissemination. When the cost is 80,000 dollar for a cure and there are 3 million infected people then one must ask if a pharmaceutical company should reap 240 billion dollars. Maybe for 8,000 per cost and then let everyone get the treatment
Hi Ed,
How about adopting a similar Netflix model for remdesivir to obviate all these curreent lawsuits? I would like to think to think Gilead would be receptive. What do you think?
I find it hard to understand the reasoning for not curing hepatitis C. We can pay a relatively small amount to forestall serious liver damage and consequent morbidity and mortality. Or we can “save” that money and pay orders of magnitude more for acute and chronic care, liver transplants, not to mention the economic impact of lower productivity or death of a hepatitis C patient. It’s like cutting costs by not changing oil in your car. Sure you save money, just nowhere near as much as that new engine will cost.
Agreed! I’m glad that some one is thinking like I am thinking.
It’s worth noting that Egypt, which once had among the highest Hep C prevalence in the world, is approaching eradication, and does full course of therapy for under $100. See Waked et al., NEJM March 19, 2020. It is profoundly stupid not to treat prisoners, in particular, for whom the infection rate is 1 in 6, so withholding treatment leads to spread into the community upon release from prison (and within prison before that).
While I agree there should be much better access, may I observe this statement is both too vague and self-serving – ” We’re hearing nearly $10,000 for a regimen, in some cases,” “We hear” is very familiar in other contexts, while ‘nearly’ could even be $15-20K, when compared to $ 80K – an anecdote rather than a fact.