Report criticizes Transparency of Managed Care Plans on Hepatitis C

Written by Nick Niedzwiadek on October 23, 2017. Published by Politico Pro. 

A number of the state’s Medicaid managed care organizations do not offer enough public information about their hepatitis C policies, according to a report released on Monday.

“New York Medicaid has made strides in improving access to hepatitis C medications due in part to very strong patient advocacy,” the report states. “However, most MCOs provide very little coverage information publicly and their requirements are unclear.”

The report, conducted by the National Viral Hepatitis Roundtable and Harvard Law School’s Center for Health Law and Policy Innovation, analyzed policies in all 50 states, Washington D.C., and Puerto Rico related to Medicaid recipients’ access to hepatitis C treatment.

The report gave New York a grade of B-. The vast majority of New York’s 6.1 million Medicaid recipients as of July were enrolled in managed care plans rather than the traditional fee-for-service model.

Unlike some other states, New York no longer restricts access to life-saving treatments to only those in the most serious condition in order to save costs, a major victory for advocates who decried a policy that seemed to require that people get sicker in order to get better.

Hepatitis C is a blood-borne virus that damages the liver and often spreads among intravenous drug users. It can lie dormant for years before showing symptoms.

The disease lacked a cure for years, and available treatments had painful side effects. Recent drugs like Sovaldi and Harvoni have proven effective, but run tens of thousands of dollars for a single course of treatment, even after rebates are factored in. Treatments for hepatitis C account for a significant portion of the state Medicaid programs’ total drug spending, though the rate of new cases has slowed, raising hopes that costs will eventually decline.

Since 2014, the state requires all physicians to offer patients born between 1945 and 1965 a hepatitis C test.

The report recommended the state remove requirements for patients to prove sobriety in order to access treatment, and to promote parity among the various Medicaid plans with regards to hepatitis C.

“With minimal changes, New York could have open access to hepatitis C treatment,” it states.

A spokesperson for the Department of Health said the agency was reviewing the report.