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CHLPI & NVHR Statement on New CDC Report Revealing Gaps in Hepatitis C Treatment in the Cherokee Nation

Originally published by HEPATITIS C: STATE OF MEDICAID ACCESS on June 12, 2023.


WASHINGTON, D.C. (June 12, 2023) – The Center for Health Law & Policy Innovation (CHLPI) of Harvard Law School and the National Viral Hepatitis Roundtable (NVHR) today urge more states to remove prior authorization requirements for hepatitis C (HCV) treatment in response to the release of a new CDC Evaluation of the Cherokee Nation Hepatitis C Virus Elimination Program. The program was launched in 2015 as an important tool to promote elimination of HCV in the largest American Indian nation. While the CDC evaluation shows progress toward this goal, systemic barriers to care remain.  

The CDC evaluation revealed that 86% of people who were diagnosed with HCV through Cherokee Nation Health Services between 2015-2020 were linked to HCV care, yet treatment was initiated for just 61% of people who were diagnosed. The report authors suggest this gap in diagnosis and treatment may be due to Medicaid and other insurers imposing prior authorization requirements that impede access to treatment. CHLPI and NVHR released the following joint statement in response:  

“The CDC’s evaluation of the Cherokee Nation Hepatitis C Virus Elimination Program underscores the pressing need to remove prior authorization and other unnecessary barriers to HCV treatment to fully realize viral hepatitis elimination. This is especially true for Indigenous communities, for whom centuries of colonial violence and the U.S. government’s failure to truly honor treaty obligations that include access to health care have created issues that didn’t exist prior to colonization and worsened health outcomes immensely. HCV disproportionately impacts American Indian and Alaska Native people, with higher rates of infection and mortality than any other demographic.

Prior authorization can take weeks or even months for insurers to approve, and the holding pattern that patients must endure during that time too often causes a break in the care continuum. In the case of hepatitis C, discriminatory and stringent requirements related to liver damage, sobriety, and prescriber specialty have disqualified patients for treatment for nearly a decade. Fortunately, we have seen an emerging trend through our Hepatitis C: State of Medicaid Access project in which more and more state Medicaid programs are taking action to remove prior authorization requirements for HCV treatment. Currently, 23 states have removed prior authorization altogether for most patients, compared to just 14 states in June 2022. States must continue to build on this important progress. The CDC evaluation illustrates how viral hepatitis elimination cannot be achieved without nationwide, sweeping removals of prior authorization requirements.  

Hepatitis C is the deadliest bloodborne infectious disease in the U.S. If left untreated, complications from the disease can be fatal. However, direct-acting antiviral treatments offer patients a near-100 percent cure rate. It is critical that insurers, policymakers, public health professionals, and health care providers take action to ensure that all people living with hepatitis C have access to widely available, cost-effective treatments, and to adequately fund Indigenous health facilities to do that vital work.” 


About the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) 

The Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) advocates for legal, regulatory, and policy reforms to improve the health of marginalized populations, with a focus on the needs of low-income people living with chronic illnesses and disabilities. CHLPI works to expand access to high-quality health care; to reduce health disparities; to develop community advocacy capacity; and to promote more equitable and effective health care systems. CHLPI is a clinical teaching program of Harvard Law School and mentors students to become skilled, innovative, and thoughtful practitioners as well as leaders in health and public health law and policy. For more information, visit www.chlpi.org

About the National Viral Hepatitis Roundtable (NVHR) 

The National Viral Hepatitis Roundtable, an initiative of HEP, is a national coalition fighting for an equitable world free of viral hepatitis. NVHR seeks to eliminate viral hepatitis in the United States and improve the lives of those affected through advocacy, education, and support to national, state and local partners. For more information, visit www.nvhr.org

Jenni Todd: (206) 934-0711 

Kyra Sanborn: (617) 496-1507 

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