Puerto Rico Lifts Barriers to Accessing Hepatitis C Treatment

Increasing access to treatment will help Puerto Rico eliminate hepatitis C and improve treatment options for more than one million Puerto Ricans.

April 27, 2020 – The National Viral Hepatitis Roundtable (NVHR), a national coalition working to eliminate viral hepatitis, and the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) today applauded Puerto Rico removing discriminatory restrictions on access to treatment for hepatitis C. Puerto Rico’s restrictions on access to treatment were limiting more than one million Puerto Ricans who are covered by the Medicaid program from accessing life-saving hepatitis C treatment.

Puerto Rico had previously received a “D” rating as part of NVHR and CHLPI’s Hepatitis C: The State of Medicaid Access report for imposing strict sobriety and narrow specialist prescribing requirements. These discriminatory barriers have been reduced and Puerto Rico has formally included hepatitis C treatment in its managed care program that covers all beneficiaries, increasing Puerto Rico to a “B” rating. These new policies coincide with updated guidance from the U.S. Centers for Disease Control and Prevention (CDC) that recommend hepatitis C screening for all adults and pregnant persons with every pregnancy.

“At least 2.3% of Puerto Ricans 21-64 years old are estimated to be living with hepatitis C, putting them at risk of developing liver cancer or passing the infection on to others,” said NVHR Director Lauren Canary. “Puerto Rico has taken the necessary steps to move towards eliminating hepatitis C, which is more important than ever as those who are living with a chronic liver disease, like hepatitis C, are at greater risk of COVID-19 complications.”

“Puerto Rico’s discriminatory restrictions were harming thousands who are living with hepatitis C, and leading to massive increases in liver cancer,” said Robert Greenwald, Clinical Professor of Law at Harvard Law School and the director of CHLPI. “We are grateful that Puerto Rico has joined the many Medicaid programs across the country that have improved access to life-saving hepatitis C treatments.”

Hepatitis C: State of Medicaid Access grades each state, as well as the District of Columbia and Puerto Rico, according to its overall “state of access.” Each grade is determined by curative treatment restrictions related to three areas: 1) liver disease progression (fibrosis) restrictions, 2) sobriety/substance use requirements, and 3) prescriber limitations – all of which contradict guidance from the Centers for Medicare & Medicaid Services (CMS), as well as recommendations from the American Association for the Study of Liver Diseases (AASLD) and the Infectious Disease Society of America. The report also offers suggestions for each state to reduce its treatment access requirements.

To read the full Puerto Rico report card, visit https://stateofhepc.org/report/#PuertoRico.