While effective clinical interventions have reduced the morbidity and mortality associated with viral hepatitis, the opioid epidemic has spurred new cases in hepatitis A, B, and C 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.
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 the extent of the problem and to animate advocacy campaigns to eliminate discriminatory coverage practices in state Medicaid programs through our State of Hepatitis C initiative. The initiative has seen tremendous success over the years. Since 2017, 33 states have eliminated or reduced their fibrosis restrictions, 29 have loosened their sobriety restrictions, and 28 have scaled back their prescriber restrictions. Additionally, there are now 11 states that have removed prior authorization for most patients entirely.
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. 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. Many states have or are developing comprehensive, systemic strategies to improve their capacity to prevent, diagnose, and provide linkage to care for viral hepatitis. Yet no grading system exists to date to assess the policy and programmatic capacity of states to eliminate viral hepatitis in the U.S.
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, as well as offers guidance for states’ ongoing efforts to develop viral hepatitis elimination strategies. Hep ElimiNATION will also offer an accompanying Viral Hepatitis Elimination Toolkit to 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 to challenge ongoing sobriety requirements used by public insurance and health care programs to limit access to HCV treatment in a manner that contradicts the medical standard of care.