Hepatitis C drug denied to many Medicaid patients

By: Emily Lunardo | Health News | Wednesday, November 25, 2015 - 10:30 AM

Hepatitis C drug denied to many Medicaid patientsA new study shows that nearly half of Medicaid patients requiring a cutting-edge hepatitis C drug have been denied due to tight controls from states as well as the high cost of the drugs. Roughly 46 percent of Medicaid patients were denied the new hepatitis C drug that could greatly improve their condition, possible even cure it. The drug is a direct-acting anti-viral drug, which cured nine out of 10 patients with chronic hepatitis C in clinically studies.

In comparison to private insurers and Medicare patients only five and 10 percent respectively were denied the medication.

There are tight pre-approval guidelines for the drugs, and their cost – $90,000 for a 12-week treatment – denies many patients who require them. Study author Dr. Vincent Lo Re III said, “These restrictions are set up to ration the medications, because of concerns that the high cost of these drugs is going to overwhelm the health care budget.”

Although the price of the treatment may appear costly, it can be even pricier to treat those with chronic hepatitis C in the long run. Early treatment could actually save the health care system billions of dollars down the road. The researchers estimated that $3.3 billion could be saved if those with hepatitis C received the medication.

Senior study author, Dr. James Kahn, said, “We found it is highly cost effective to treat everyone right away, rather than waiting for them to progress to more advanced liver disease.”

If untreated hepatitis C can cause severe damage to the liver, which could require a liver transplant.

Common reasons for drug refusal were, “insufficient information to assess medical need” (48 percent), “lack of medical necessity” (31 percent) and a positive alcohol/drug screen (4 percent).

Tom Nealon, chief executive officer of the American Liver Foundation, added, “Everybody has adopted the idea that putting this off makes the most sense. But when you think of the cost of treating people for years for cirrhosis and liver cancer and then transplants, this would be an incredible savings, not to mention what it does for the quality of life for these people.

Researchers suggest that even if insurers don’t pay for the drugs in the early stage they will eventually have to pay for them in the later stages of the disease. By allowing early treatment, insurers can avoid costs associated with long-term damage.

The findings were published in JAMA Internal Medicine.


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