On Monday a federal district court in Austin granted final approval of a class action settlement between the Texas Health & Human Services Commission (“HHSC”) and Medicaid enrollees, radically expanding access to prescription drugs that cure hepatitis C virus (“HCV”) for Medicaid enrollees throughout Texas.
In the initial complaint for Coleman v. Wilson, Plaintiffs Dorena Coleman, Curtis Jackson and Federico Perez alleged that the HHSC prioritized financial concerns over their health by restricting coverage of direct-acting antiviral treatment (“DAAs”) for HCV to only those Medicaid enrollees with severe liver damage, even though the treatment results in a cure for nearly 100% for all individuals infected with HCV.
The plaintiffs’ lawyers, including the Center for Health Law & Policy Innovation of Harvard Law School, Edwards Law Group, and Latham & Watkins LLP, secured a settlement with HHSC to remove the discriminatory treatment access restrictions.
As a result of the lawsuit, HHSC rewrote its policy, expanding access to DAAs to Medicaid enrollees diagnosed with HCV regardless of liver damage, and removing sobriety and prescriber requirements for HCV treatment. The new policy came into effect on September 1, 2021. At a final fairness hearing on Monday, the parties informed the court about the overwhelmingly positive impact of the new policy on Medicaid recipients throughout Texas, and the court granted final approval of the settlement from the bench, to be confirmed in a subsequent written order.
“I am grateful that Texas Medicaid has relegated its discriminatory coverage for Hepatitis C care to the ash heap of history. Denying Medicaid beneficiaries the medical care they need based on fiscal concerns is dangerous, especially when there is no equally effective treatment available,” said Kevin Costello, director of litigation for the Center for Health Law and Policy Innovation of Harvard Law School. “We are proud of our settlement agreement with HHSC and the resulting positive impacts it will have for Texans enrolled in Medicaid.”
“The settlement ended a discriminatory practice denying thousands of Texans suffering with hepatitis C the treatment that would cure their disease simply because they were poor,” said Jeff Edwards of Edwards Law Group. “As a consequence, Texas is now a much safer and fairer place in which to live.”
“At stake in this lawsuit was the denial of fundamental medical treatment. We are satisfied that this settlement will result in immense positive public health benefits for Texas Medicaid recipients,” said David Tolley, partner at Latham & Watkins.
HCV is a deadly communicable disease that, if left untreated, can lead to serious liver damage, infections, liver cancer, and death. Treatment guidelines confirm that DAAs should be available for “all patients with chronic HCV infection, except those with short life expectancies that cannot be remediated by treating HCV, by transplantation, or by other directed therapy.” This clinical guidance reflects the medical standard of care across the country. By removing treatment access restrictions to DAA treatment, HHSC joins the vast majority of state Medicaid programs throughout the country that cover HCV treatment for beneficiaries.