The U.S. is facing rising rates of viral hepatitis – despite the availability of vaccines for hepatitis A and B, and a cure for hepatitis C – and reports show that the country is not on track to meet the World Health Organization’s goal of eliminating viral hepatitis by 2030. While effective clinical interventions have reduced the morbidity and mortality associated with viral hepatitis, the opioid epidemic has spurred new cases at alarming rates that disproportionately burden already disinvested communities.
Newly developed direct-acting antiviral drugs can cure up to 99% of people living with hepatitis C—one of the deadliest communicable diseases in the United States. While the price of the cure has dropped dramatically over the past several years, many state Medicaid programs continue to implement unprecedented treatment access restrictions that violate federal law.
The Center for Health Law and Policy Innovation (CHLPI) is engaged in a multi-pronged national advocacy and litigation campaign to end discriminatory restrictions to curative hepatitis C treatment, and to champion laws and policies that support the elimination of viral hepatitis altogether.
CHLPI partners with the National Viral Hepatitis Roundtable (NVHR) to highlight discriminatory hepatitis C treatment coverage practices in state Medicaid programs and to animate advocacy campaigns to eliminate these harmful barriers. Hepatitis C: State of Medicaid Access tracks Medicaid policies in the 50 states, Washington, D.C., and Puerto Rico via national reports and individual state report cards. The initiative has seen tremendous success over the years. Between 2017 and 2022, 33 states eliminated or reduced their fibrosis restrictions, 29 loosened their sobriety restrictions, and 28 scaled back their prescriber restrictions. And as of January 2023, 19 states have now removed prior authorization altogether for most patients. Yet barriers to hepatitis C treatment remain in many states, and Hepatitis C: State of Medicaid Access continues to shed needed light on state Medicaid coverage policies across the country.
CHLPI and the National Viral Hepatitis Roundtable are also partnering with the O’Neill Institute for National and Global Health Law at Georgetown University Law Center to study viral hepatitis elimination efforts in the U.S. Via a grade-based scorecard system, Hep ElimiNATION: A National Evaluation of States’ Capacity for Viral Hepatitis Elimination assesses the policy landscape and programmatic strategies impacting viral hepatitis elimination in the 50 states, Washington DC, and Puerto Rico, and offers guidance for states’ ongoing efforts to develop viral hepatitis elimination strategies. Hep ElimiNATION is in the process of developing a Viral Hepatitis Elimination Toolkit that will outline the components of a comprehensive viral hepatitis elimination program and key benchmarks for assessing progress.
CHLPI co-authored the earliest and most comprehensive 50 state study of such Medicaid restrictions, published in early 2015 in the Annals of Internal Medicine. After analyzing these findings, we engineered a successful national litigation campaign targeting illegal government policies restricting access to health care for individuals living with Hepatitis C. Our litigation work has improved access in 13 states and served as the model for similar efforts in many more. Among our published opinions in these cases are the following:
- B.E. v. Teeter, No. C16-227-JCC, 2016 WL 3033500 (W.D. Wash. May 27, 2016) (granting preliminary injunction striking down disease severity restrictions on HCV treatment in Washington Medicaid);
- Ryan v. Birch, No. 17-CV-00904-KLM, 2017 WL 3896440 (D. Colo. Sept. 5, 2017) (denying motion to dismiss of Colorado Medicaid in case challenging disease severity restrictions for HCV treatment);
- West v. Gobeille, 450 F. Supp. 3d 497 (D. Vt. 2020) (certifying class of Vermont inmates and denying motion to dismiss constitutional challenge to HCV policies and practices of state department of corrections).
CHLPI continues this important work, developing an important litigation theory under the Americans with Disabilities Act to challenge ongoing sobriety requirements imposed by public insurance and health care programs to limit access to hepatitis C treatment. This litigation theory forms the basis of two federal administrative complaints CHLPI filed in 2022 with the Department of Justice, arguing that Medicaid programs in both Alabama and Mississippi illegally denied hepatitis C treatment to people with substance use disorder. In December 2022, the Justice Department announced it had reached a settlement with Alabama Medicaid after Alabama Medicaid expanded access to hepatitis C treatment to people with substance use disorders.