Hepatitis C medications costly for Medicaid

Feb 10, 2016

BY: Citizens Count

For Hepatitis C patients, new drugs like Solvadi and Harvoni are a miracle cure: a single course of treatment completely cures 90 percent of patients of the disease. However, the miracle comes at a cost. A twelve-week course of treatment with Harvoni runs roughly $95,000, and related drugs are similarly expensive.

This has led many states, including New Hampshire, to treat the drugs differently than other prescriptions for Medicaid patients, requiring physicians to submit a request to the DHHS before a prescription is approved for reimbursement.

Currently New Hampshire allows use of Solvadi and other top-tier Hepatitis C drugs only for those patients showing signs of advanced liver scarring. The state also asks patients if they are HIV positive or receiving treatment for drug or alcohol abuse before approving prescriptions. If not treated, Hepatitis C can lead to liver failure or cancer.

Supporters of the current policy argue that authorizing universal coverage of these extremely expensive medications would bankrupt the state’s health care system or place an undue additional burden on taxpayers. They note that there are alternative Heptatitis C treatments available at far less cost which, while not as powerful, can still work to effectively combat the disease in many patients.

Critics, however, question the ethics of requiring patients to get sicker before they can receive a proven, effective treatment, noting that the liver damage caused by Hepatitis C is not reversible. Others argue that the expense of Solvadi is justified, as it is less costly than the long-term costs of care for Hepatitis C patients. Additionally, concerns have been raised over whether denying coverage for the drugs is actually legal, with lawsuits filed in several states.

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