Published by the Bozeman Daily Chronicle on Thursday, January 25, 2018. Written by
Montana’s Medicaid program requirements are blocking hepatitis C patients from treatment, according to a national report released recently. An estimated 15,000 people in the state are living with hepatitis C, according to the National Viral Hepatitis Roundtable. The illness kills more people in the U.S. than any other infectious disease.
The report, Hepatitis C: State of Medicaid Access — created by the roundtable and the Center for Health Law and Policy Innovation of Harvard Law School — grades all 50 state Medicaid programs according to access to treatments for the disease.
Montana received a failing grade for “imposing discriminatory restrictions on hepatitis C cures,” according to the report. Dr. Ray Geyer, an infectious disease specialist based in Great Falls, said he hopes that grade provokes the state to lift its restrictions
“Montana’s ‘F’ grade comes as no surprise to those of us who’ve seen first-hand the hoops our state’s Medicaid patients must jump through to access a cure for hepatitis C,” Geyer said.
Montana’s program, Passport to Health, requires hepatitis C patients to demonstrate severe liver damage, six months of sobriety and a prescription from a specialist — which can be costly and difficult to find — before they can access treatment. According to the report, more than 1,000 cases of hepatitis C are reported in Montana every year, many from the baby boomer generation. Not every person diagnosed relies on Medicaid for coverage.
Jon Ebelt, a spokesperson with the state health department, said since 2014, Montana has approved 266 requests for Medicaid coverage of hepatitis C treatment.
Sheila Hogan, the director of Montana’s state health department, said in a statement Thursday afternoon that the high cost of prescriptions drugs, like medications for hepatitis C, is one of the major hurdles to deliver health care. “This challenge is reflected in the grade Montana and more than half of the states in this report received. If prescription drug costs were lower, more Montanans could get this treatment for Hepatitis C,” Hogan said. Montana was one of five places marked with a failing grade.
Dr. Mark Winton, an infectious disease specialist with Bozeman Health, said the state’s fibrosis score system isn’t “in line with current medical practices.” “Anything that delays treatment increases the risk of complications,” he said.
Robert Greenwald, clinical professor of law at Harvard Law School and the director of the school’s health law center, agreed that the state’s rules around patient sobriety is “medically unfounded” and said it puts others at risk. “Even though the opioid crisis is exacerbating the hepatitis C epidemic, Montana is preventing patients who have used drugs in the past six months, the population most likely to spread this highly communicable disease, from accessing a cure,” Greenwald said.
The report authors call for Montana to remove its restrictions around liver damage, sobriety and where patients have to go for prescriptions. They also ask the state to maintain transparency around criteria of hepatitis coverage.
Ryan Clary, the executive director of the roundtable, said without those steps few people with hepatitis C have access to treatment. “Connecting Medicaid recipients with a cure is vital to stopping this life-threatening virus from wreaking havoc on Montanans and Americans,” Clary said. “Our hope with this project is for states with failing grades like Montana to see how they compare and to take steps to ensure all hepatitis C patients have access to effective treatment.”
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