Colorado Lifts Restrictions for Treating Hepatitis C Patients; No Longer Need to Have Advanced Liver Damage to Receive Drugs

Originally published by the Denver Post on December 1, 2017. Written by Jennifer Brown.

Colorado soon will begin treating needy hepatitis C patients with the latest antiviral drugs instead of waiting until they are sick enough to qualify.

Friday’s decision by the state Medicaid department comes in the midst of a class-action lawsuit filed by the American Civil Liberties Union of Colorado and after top health officials asked the department to lift restrictions that determined which patients could receive life-altering treatment.

It also comes as the price of the antiviral drugs—which cure up to 90 percent of patients—has dropped from $84,000 per treatment to about $14,000.

Colorado’s previous policy, which required Medicaid recipients with the virus to have advanced liver damage in order to receive treatment, was “unconscionable,” said Kevin Costello with Harvard Law School’s Center for Health Law and Policy Innovation, a partner in ACLU’s suit.

“Were a cure for cancer to be discovered, no one would tolerate insurance providers telling patients: ‘We need to wait until you get really sick before we treat you,’” he said in a statement after Colorado’s announcement.

Until about two years ago, the best treatment for hepatitis C included year-long, toxic injections with often-miserable side-effects and an estimated cure rate of only 50 percent. The latest antivirals, pills taken for as few as eight weeks, come with few side-effects and a 90 percent cure rate.

Because of the price drop, the state Medicaid department expects to spend the same yearly amount on treatment but treat about 20 percent more patients. Other states that lifted restrictions treated 5 to 50 percent more people, said Dr. Judy Zerzan, chief medical director for the Colorado Department of Health Care Policy and Financing.

Department officials said budget figures showing how much the Medicaid department spent last year treating patients with hepatitis C were unavailable Friday. Zerzan said in 2016 that the department spent $26.6 million treating 326 hepatitis C patients—an average cost of $82,000 per person.

Friday’s policy change, she said, was “part of our usual process (in) keeping up with the pace of change and the evidence” and not related to the lawsuit. The new rules take effect Jan. 1.

Among those who asked the Medicaid department to change policy was Denver Public Health director Bill Burman. In a letter to the department last year, Burman wrote that the drug restrictions were leading to more health disparity and death at Denver Health, the largest health care provider for low-income people in Denver.

In addition, the federal Centers for Medicare and Medicaid warned states against imposing “unreasonable” restrictions of the antiviral drugs. Medical associations have recommended the treatment for all people with hepatitis C, not just those in the later stages of liver scarring.

Dr. Sarah Rowan, associate director of HIV and viral hepatitis prevention at Denver Public Health, said she was thrilled to learn of the new policy while in Spain for World AIDS Day. “This marks a critical turning point in the epidemic,” she said via email.

The lawsuit against the Medicaid department is pending. Because the suit is a class-action one, a judge, not the attorneys, must determine whether to dismiss it.

ACLU of Colorado legal director Mark Silverstein called the policy change “a major step forward” to resolving the lawsuit and a “more fiscally sound path” for the state because patients will receive treatment before they have suffered serious liver damage.