Under pressure from the American Civil Liberties Union, Colorado announced Thursday it would expand existing coverage of Medicaid patients for expensive hepatitis C treatments, the Denver Post reported.
Hepatitis C is a blood-borne infectious disease that attacks the liver and can lead to liver failure, cancer and even death. An estimated 14,400 Coloradans on Medicaid currently have hepatitis C.
Colorado’s previous policy for hepatitis C treatment only covered Medicaid patients in the third and fourth stages of the disease, due to the high cost of new hepatitis drugs available since 2013.
Old drugs required extended treatment and caused painful side effects for only a 50 to 70 percent success rate. The new drugs, like Gilead’s Sovaldi, are 90 percent effective in treating patients with one pill a day, over a 12-week course and side effects are minimal. But the drugs are very costly, about $86,700 per person. So far Colorado Medicaid has spent $35.8 million treating 413 hepatitis C patients, according to the Denver Post.
New coverage has been extended to cover patients in the second stage of the disease, as well as all women who plan to become pregnant within a year to prevent the spread of the hepatitis C to an unborn child.
The policy will also loosen restrictions on providing treatment to drug and alcohol users, now requiring that patients with a history of abuse enroll in counseling for one month prior to starting the course of medication. One caveat is that the state will rely on physician judgement to determine whether to distribute the drug on a case-by-case scenario.
Colorado’s previous policy attracted criticism from the ACLU and Denver Public Health. The ACLU argued that it is wrong to withhold treatment from patients until they suffer cirrhosis just because of the cost of a drug.
Critics have also argued that barring intravenous drug users from treatment will only enable the spread of the disease. Dr. Sarah Rowan, Denver Public Health associate director of HIV and viral hepatitis prevention, told the Post treating intravenous drug users is the “most important way to stop the spread and slow this epidemic around the country.”
Criticisms like these and a recommendation from Colorado’s Medicaid Drug Utilization Review Board, which guides the state’s drug coverage for programs like Medicare and Medicaid, prompted the state to rethink the policy. But no decisions were made until the ACLU threatened to force its hand with a lawsuit, according to the Denver Post.
“This is a definite improvement over the past restrictions but unfortunately, it doesn’t go far enough,” ACLU Legal Director Mark Silverstein told the Post. “It still leaves many people with hepatitis C without treatment — treatment that is medically necessary and is being denied for reasons that are not medical reasons.”
Officials estimate that 20 percent of hep C-positive Medicaid patients will seek treatment within the next year, costing approximately $35.8 million.
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