Legal battles are being waged by the Attorney General in New York and others against insurers that balked at covering expensive hepatitis C drugs, while federal Medicaid officials have warned states over not providing the drugs. Now the American Civil Liberties Union is upping the pressures with several lawsuits around the country.
Having already filed a class action suit against the Indiana Family and Social Services Administration and a lawsuit against the Tennessee Department of Corrections, the ACLU in Colorado is now threatening to sue the state's Medicaid program for only covering the new gen hep C drugs for people whose liver disease has reached an advanced stage.
In a recent letter to Colorado officials, ACLU pointed to guidelines issued last year by the federal Centers for Medicare and Medicaid, which reminded them "of their obligation to provide access to these promising therapies based on the medical evidence.” At the time that it warned states, the federal agency also insisted the drugmakers, including Gilead Sciences ($GILD)--which dominates the market for the drugs--and competitor AbbVie ($ABBV), provide state programs with the lowest discounted price they offer to anyone else.
Colorado rebuffed the ACLU's threat, the Denver Post reports, by pointing out the fed’s action came in the form of guidelines, not a mandate. The state also claimed the guidelines do not require Colorado to pay for expanded use of the drugs.
The fight in Colorado mirrors actions elsewhere. In May, New York Attorney General Eric Schneiderman’s office sued health insurer CDPHP for delaying coverage of hep C treatments until patients are in advanced stages of the disease. The suit alleges CDPHP restricted coverage of hep C treatments over their cost without disclosing in health plan documents that cost was a factor in determining coverage. The insurer also has not revealed how it determines when benefits will be covered, which the AG’s suit said violated state health and insurance laws.
But at least one state, Massachusetts, is handling the issue for its Medicaid patients with a much more innovative approach. It followed the example of some large payers and recently struck a deal for rebates from Gilead in exchange for making hep C cure Harvoni “the exclusive therapy” for about 80% of the MassHealth members infected with the virus. The other 20% are expected to get Gilead’s Sovaldi and Bristol-Myers Squibb’s Daklinza, for which the state said it also has worked special deals.
- read the Denver Post story
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