Harvard Law School & National Viral Hepatitis Roundtable Announce Preliminary Findings in Project to Grade Medicaid Access to Hepatitis C Treatment

The National Viral Hepatitis Roundtable (NVHR) and the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) today announced the preliminary findings of Hepatitis C: The State of Medicaid Access – a comprehensive assessment of state Medicaid programs’ discriminatory restrictions on curative treatments for hepatitis C, the nation’s deadliest blood-borne disease. The full report, with accompanying rankings and state-by-state report cards, will be released in early 2017.

Preliminary analysis from Hepatitis C: The State of Medicaid Access – announced today at The Liver Meeting® in Boston – shows some improvements in both state Medicaid program transparency and access since 2014, yet also demonstrates that most states continue to impose discriminatory restrictions which contradict guidance from the Centers for Medicare & Medicaid Services (CMS), as well as guidance from AASLD and the Infectious Disease Society of America.  Also concerning is that nearly half of states may not be making all restrictions publicly available.

The Hepatitis C: The State of Medicaid Access final report will grade and rank each state, as well as the District of Columbia, according to overall “state of access,” as determined by curative treatment restrictions related to three areas: 1) liver disease progression (fibrosis) requirements, 2) sobriety requirements, and 3) provider limitations. The report will also provide the first-ever national assessment of Medicaid Managed Care Organization (MCO) coverage of curative HCV treatments.

“With this announcement, we are officially putting state Medicaid programs on notice,” said Ryan Clary, executive director of NVHR. “State Medicaid directors need to make all treatment criteria publicly available and detail any plans to comply with CMS guidance, which clearly states that coverage policies cannot block hepatitis C patients’ access to effective, clinically appropriate and medically necessary treatments. It is unacceptable to have discriminatory restrictions that conflict with the CMS guidance or with established hepatitis C treatment standards. Our final report will grade and rank each state’s access criteria, and states that continue to discriminate will be called out.”

Robert Greenwald, clinical professor of Law at Harvard Law School and the faculty director of CHLPI, commented, “There is some good news and some bad news here.  In comparing our current findings to a 2014  hepatitis C treatment access report I published with a team of researchers in the Annals of Internal Medicine, we find that many states have reduced discriminatory practices.  Disappointingly, we also find that restrictions persist in many states, despite our hope that with established treatment guidelines, clear guidance from CMS, and successful litigation, we would see far more progress in eliminating discriminatory hepatitis C treatment restrictions.”

Greenwald continued, “While I think there is a general consensus emerging that discriminatory hepatitis C treatment restrictions will eventually be removed, voluntarily or by courts, we must hold state Medicaid programs accountable now, as some states still see a budgetary incentive in dragging their feet as long as possible.”

Key preliminary findings of the Hepatitis C: The State of Medicaid Access project include:

• Transparency surrounding state Medicaid program hepatitis C treatment access restrictions has increased overall since 2014;
• Access to hepatitis C treatment has improved since 2014 – primarily in the reduction/elimination of liver disease or fibrosis restrictions, while access restrictions related to sobriety and prescriber limitations have decreased to a far lesser extent; and
• While there are some MCOs with low levels of restrictions, many follow their states’ fee-for-service (FFS) Medicaid restrictions, while others impose more onerous restrictions in violation of federal law.

NVHR and CHLPI are asking state Medicaid directors to confirm all current treatment restrictions for curative hepatitis C treatments, and to detail any plans to broaden access and comply with CMS guidance. Medicaid officials may contact Ryan Clary (rclary@nvhr.org) and Robert Greenwald (rgreenwa@law.harvard.edu).

States for which fibrosis, sobriety, and/or provider requirements remain unknown include: Alabama, Alaska, Arkansas, California, Delaware, Georgia, Indiana, Kentucky, Maine, Michigan, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, South Carolina, Tennessee Utah, Washington, and Wyoming.

According to the Centers for Disease Control and Prevention, hepatitis C affects approximately 3.5 million Americans. For the past several decades, hepatitis C treatment regimens revolved around painful interferon injections, which are vastly ineffective at managing the disease on an individual level and the epidemic on a public health level. In contrast, the new generation of treatments offer cure rates of near 100 percent with minimal side effects, providing hepatitis C patients with an unprecedented chance to live virus-free – and avoid liver failure, cancer-causing cirrhosis, liver transplants, and other health complications.

Read “Hepatitis C: The State of Medicaid Access.”