Under Pressure from Advocates, PA Announces Medicaid Policy Change for Individuals Suffering from HCV

On May 16, 2017, Pennsylvania’s Department of Human Services (DHS) is announcing changes to the state’s Medicaid policy to expand coverage of life-saving drugs to treat Hepatitis C (HCV). The policy change follows the clinical recommendations presented by the department’s Pharmacy & Therapeutics Committee. Under the new policy, the department will authorize the drugs for beneficiaries with test scores of F1 starting on July 1, 2017, and will authorize treatment for beneficiaries with scores of F0 starting on January 1, 2018. Previously, this treatment was only available to individuals whose scores ranged from F2 through F4, unless they also had other clinical complications.

The announcement is the results of negotiations with attorneys from the Center for Health Law & Policy Innovation of Harvard Law School, the Pennsylvania Health Law Project, Community Legal Services, and Kairys, Rudovsky, Messing & Feinberg, LLP. In late 2016, the group sent a formal demand letter to Pennsylvania officials on behalf of their clients, Pennsylvania Medicaid recipients. The demand letter notified DHS that unless it agreed to remove categorical coverage exclusions of HCV cures from its Medicaid policy, the state could face a federal class action lawsuit.

CHLPI is engaged in a state-by-state campaign to challenge similar policies and count successes in Massachusetts, Washington, and Delaware among previous victories. Kevin Costello is leading the charge, and says “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.’ But that’s what patients in Pennsylvania with Hepatitis C were being told, and what patients in other states are still being told. While the future of health care in our country remains unclear, it is important for state Medicaid programs to live up to their promise of caring for the most vulnerable among us.”

Read a press release on the agreement from the Wolf Administration.