January 11, 2016 — Medicaid programs in at least 34 states do not pay for the expensive hepatitis C treatment Harvoni unless a patient already has liver damage, leaving many victims waiting until they are sick enough to be cured.
National Public Radio (NPR) talked to Sarah Jackson, a woman who was prescribed Harvoni. She has not started treatment because her insurance, Indiana’s Medicaid, has refused to provide coverage. In the meantime, she has joined a class action lawsuit to fight the restrictions.
The lawsuit cites a letter from the Center for Medicare and Medicaid Services reminding states that they must provide coverage for drugs that are prescribed for medically necessary conditions. According to her attorney:
“If something is medically necessary, it’s medically necessary and must be covered by the Medicaid program.”
Some say the enormous up-front cost is justified by lower costs and long-term benefits down the road — such as avoiding spreading hepatitis C to other people.
Sovaldi and Harvoni have far fewer serious liver side effects than other hepatitis C drugs. Treatment also significantly reduces the odds of a patient developing liver cancer or needing a liver transplant, which can cost hundreds of thousands of dollars.
According the World Health Organization (WHO), as many as 3 million people in the United States and 150 million people worldwide are infected with hepatitis C. The highly-contagious viral disease often spreads on dirty medical equipment or by drug-users who share needles.