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.

Unlock this article by subscribing to STAT Plus and enjoy your first 30 days free!


What is it?

STAT Plus is STAT's premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis. Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond.

What's included?

  • Daily reporting and analysis
  • The most comprehensive industry coverage from a powerhouse team of reporters
  • Subscriber-only newsletters
  • Daily newsletters to brief you on the most important industry news of the day
  • STAT+ Conversations
  • Weekly opportunities to engage with our reporters and leading industry experts in live video conversations
  • Exclusive industry events
  • Premium access to subscriber-only networking events around the country
  • The best reporters in the industry
  • The most trusted and well-connected newsroom in the health care industry
  • And much more
  • Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr.
  • 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.

  • 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.

Comments are closed.

Sign up to receive a free weekly opinions recap from our community of experts.
Privacy Policy