Over the past few years, state Medicaid programs have done a better job of disclosing information about access to expensive hepatitis C medicines and fewer are restricting treatments to patients, according to a new analysis.
For the first time, each state program has released treatment criteria. And since 2017, 32 states have either removed or eliminated restrictions based on a patient’s stage of liver disease, 21 have loosened rules that required patients to demonstrate they have not abused or drug or alcohol for a period of time before starting treatment, and 25 state scaled back prescribing restrictions for health care providers.
Moreover, seven states have removed all treatment restrictions and also eliminated requirements for prior authorization, according to the latest survey of Medicaid programs by the Center for Health Law and Policy Innovation at Harvard Law School and the National Viral Hepatitis Roundtable. Prior authorization refers to obtaining approval before a medicine can be prescribed.
“Overall, we see restrictions far less frequently than we had,” said Phil Waters, a staff attorney at the CHLPI, which had filed lawsuits against two state Medicaid programs over the issue and also receives pharmaceutical industry backing. “But the momentum has kind of stopped since we launched this project in 2017. It seems that the states that are going to remove restrictions have removed them.”
The progress has been tracked by the organizations since the Centers for Medicare and Medicaid Services warned state Medicaid programs in 2015 that they may be violating federal law by restricting access to hepatitis C medicines, which were described as “medically necessary.” The warning was issued as the states struggled with the high cost of new hepatitis C treatments.