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Press Release: Science, Not Stigma, Must Drive Hepatitis C Treatment Decisions
FOR IMMEDIATE RELEASE
Medicaid Health Plans Should Use Science, Not Stigma, to Make
Hepatitis C Treatment Decisions
Medicaid Health Plans of America CEO Perpetuates Myths about Treating
People with Substance Use Disorders for Hepatitis C
Washington, DC, November 12, 2015 – On November 5, 2015 the Centers for Medicare & Medicaid Services (CMS) issued a notice to all 50 state Medicaid directors regarding their obligation to provide beneficiaries living with hepatitis C access to curative treatment medications, and warning that rationing access based on severity of liver disease, substance use, and other factors for cost-containment purposes violates federal law.
From November 11-13 the trade group Medicaid Health Plans of America (MHPA) hosts its annual conference and plans a breakout session, “Differentiating Strategies from Tactics in Hepatitis C Management,” on November 12. We hope the presenters will decry recent statements from MHPA’s CEO, Jeff Myers, who, in response to the CMS notice, made stigmatizing statements to the media that defy both the science of hepatitis C treatment and the federal laws outlined in the CMS notice. He “defended barring heavy alcohol users from having access to hepatitis [C] drugs, since the ongoing damage to their livers could counteract the drug's effectiveness.” He also said that intravenous drug users might not have the mental capability to complete a full course of hepatitis treatment, an assertion as damaging as it is false. Mr. Myers asserted that Medicaid health plans’ prior authorization policies are “perfectly legal” and “firmly rooted in medical efficacy.”
“The professional guidance for treating hepatitis C is clear – treatment is recommended and beneficial for all patients with hepatitis C, unless they have a short life expectancy. Medicaid health plans have an obligation to follow the best available science and stop creating prior authorization policies based on cost containment concerns that bar people from medically necessary treatment,” stated Emalie Huriaux, Director of Federal and State Affairs for Project Inform.
The American Association for the Study of Liver Diseases and the Infectious Diseases Society of America (AASLD), the foremost professional groups with expertise in treating hepatitis C in the United States, citing the abundant scientific literature in their guidance document “Recommendations for Testing, Managing, and Treating Hepatitis C,” note that excluding people from hepatitis C therapy based on the amount of alcohol they drink is not supported by data. In fact, curing hepatitis C in people who drink heavily is imperative to mitigate liver damage. While alcohol can worsen liver damage in general, there is no evidence that alcohol use counteracts the efficacy of hepatitis C treatment medications in curing the disease.
AASLD guidance also notes that “[t]here is strong evidence from various settings in which persons who inject drugs have demonstrated adherence to treatment and low rates of reinfection, countering arguments that have been commonly used to limit access to this patient population […] Conversely, there are no data to support the utility of pretreatment screening for illicit drug or alcohol use in identifying a population more likely to successfully complete [hepatitis C] therapy. These requirements should be abandoned, because they create barriers to treatment, add unnecessary cost and effort, and potentially exclude populations that are likely to obtain substantial benefit from therapy. Scale up of [hepatitis C] treatment in persons who inject drugs is necessary to positively impact the [hepatitis C] epidemic in the United States and globally.”
“All people living with hepatitis C deserve access to effective, curative treatments just as individuals living with any other disease deserve access to the medications they need,” notes Christine Rodriguez, Senior Policy Manager for the National Viral Hepatitis Roundtable. “Myers’ comments are particularly disturbing, however, given the role of Medicaid programs to provide access to quality care for some of the most marginalized people in our communities.”
“We call on Jeff Myers and MHPA to promote the necessity of basing hepatitis C treatment decisions on science, rather than stigma, and encourage MHPA members to follow the federal laws outlined in the CMS notice,” states Carl Schmid, Deputy Executive Director of The AIDS Institute. “Anything less is unethical and undermines efforts to eliminate the hepatitis C epidemic in the United States.”
The AIDS Institute is a national bipartisan, nonprofit organization that promotes action for social change through public policy, research, advocacy, and education. It began as a grass roots community mobilization effort in 1985. Over the years, The AIDS Institute has expanded its vision to become a respected national leader dedicated to supporting and protecting health care access for people living with HIV/AIDS, Hepatitis, and patients living with chronic diseases. We achieve our mission through our National Policy Office in Washington, DC; Program and Administrative offices in Tampa, FL, and Research and State Policy in Tallahassee, FL. For more information about The AIDS Institute, visit www.theaidsinstitute.org.
The National Viral Hepatitis Roundtable (NVHR) is a broad coalition working to fight, and ultimately end, the hepatitis B and hepatitis C epidemics. We seek an aggressive response from policymakers, public health officials, medical and health care providers, the media, and the general public through our advocacy, education, and technical assistance. NVHR believes an end to the hepatitis B and C epidemics is within our reach and can be achieved through addressing stigma and health disparities, removing barriers to prevention, care and treatment, and ensuring respect and compassion for all affected communities. For more information about NVHR, visit www.nvhr.org.
Project Inform believes it is possible to create the first generation free of HIV and hepatitis C within the next decade. To achieve this dream, Project Inform focuses our work in four areas: drug development, bio-medical prevention, education, and health care access. Project Inform encourages the development of better treatments and cures for both HIV and hepatitis C; advocates for innovative, medically-based prevention strategies; provides up-to-date, lifesaving information to help people living with HIV and hepatitis C make the best choices regarding their treatment and care; and presses governments to set policies and assure unlimited access to affordable health care that will one day end the HIV and hepatitis C epidemics. For more information about Project Inform, visit www.projectinform.org.