Experts: Fight Hepatitis C epidemic with more testing, caps for co-pays

WASHINGTON, D.C. ( June 4, 2015 ) — With mounting evidence that many public and private health plans are deliberately rationing care for Americans with the hepatitis C virus (HCV), those on the front lines in fighting viral hepatitis and HIV/AIDS today urged lawmakers to overturn state Medicaid and managed care policies that discourage testing, add prior authorization requirements on clinicians, and create significant hurdles for patients to receive new curative treatments — all contributing to only 5% to 6% of individuals with HCV being successfully treated.

Assembling in Washington for the 2015 National Summit on HCV and HIV Diagnosis, Prevention and Access to Care, HCV and HIV specialists called on policymakers to pass state laws mandating that insurance plans follow evidence-based medical guidelines when covering HCV testing and treatment. These guidelines — published jointly by the American Association for the Study of Liver Diseases ( AASLD ) and the Infectious Diseases Society of America ( IDSA ) and also by the Department of Veterans Affairs — support treatment in all HCV-infected people except those with a life expectancy of less than a year due to non-liver medical conditions. Moreover, the advocates urged states to enact laws requiring Medicaid programs to offer first-line HIV medications and new HCV drugs on their formularies and to cap the co-payments for these therapies, ending system-wide practices by both public and private insurers that restrict access to these drugs.

These actions are necessary now that a just-issued review of ten state Medicaid programs from the Center for Health Law and Policy Innovation of Harvard Law School documents system-wide insurance restrictions that keep the majority of HCV-infected individuals from being treated with new and more expensive oral HCV drugs. While the practices vary from state to state, and even among different plans in the state, they are designed to be exclusionary by only allowing patients with advanced liver disease to receive the new drugs, authorizing only a small number of medical specialists to prescribe the drugs, excluding alcohol- and substance-using individuals, and restricting access based on HIV co-infection. These exclusionary practices also apply to a number of private health plans, resulting in a series of lawsuits in California.

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