New York insurers cave on hep C coverage amid pushback from AG

Eric Schneiderman

The New York Attorney General's office’s pushback over hep C drug coverage is finally starting to pay off: After limiting coverage for next-gen antivirals, 7 insurers have now agreed to cover treatment for almost all commercially insured patients in New York.

Insurers including Affinity Health Plan, Anthem ($ANTM) subsidiary Empire BlueCross BlueShield, Excellus BlueCross BlueShield, HealthNow New York, Independent Health, UnitedHealth ($UNH) subsidiary Oxford Health Plans and MVP Health Care will now cover new hep C drugs for patients who don’t have advanced forms of the disease. The companies also can’t deny coverage based on patients’ drug and alcohol use. In return, the AG’s office will drop its investigations into the plans, The Wall Street Journal reports.

The deals mark a bright point for New York AG Eric Schneiderman, whose office has been probing insurance companies over questionable hep C drug coverage. Last year, Schneiderman’s office issued subpoenas requesting documents and claims data from all commercial health insurers in New York.

The investigation turned up some troubling information. Five of the insurers denied 30% to 70% of claims. And some insurers only covered patients with advanced stages of the disease, according to the WSJ story. EmblemHealth and Aetna ($AET) were the only insurers that consistently covered patients at earlier stages of the disease.

Last week, Schneiderman stepped up his fight against insurers limiting coverage of pricey hep C meds. The New York AG’s office sued health insurer CDPHP for breaking the law by delaying coverage of hep C treatments until patients have an advanced form of the disease.

“Forcing patients to wait for care, risking internal organ damage, is unconscionable and, as we allege in our lawsuit, violates the law and the company’s own policies,” Schneiderman said in the suit.

Even though the latest developments mark a step in the right direction, they’re not a universal salve, Brian Edlin of Weill Cornell Medical College told the WSJ. The agreements only focus on commercial insurers, and many Medicaid plans still do not offer coverage due to the drugs’ high costs. Gilead’s ($GILD) hep C combo Harvoni, for example, carries a list price of $94,500 a treatment course, a number that some insurers balk at paying.

“Medicaid insurers are continuing to impose these severe restrictions and onerous prior authorization processes,” Edlin said. “Consequently, this disease will become increasingly a disease of the poor, and health inequities that already exist will sharpen.”

- read the WSJ story (sub. req.)

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