Colorado board recommends expanded coverage for hepatitis C drug

Board: More needy should get new drugs
By John Ingold
| The Denver Post

Staff attending the Colorado Medicaid drug utilization review committee of Colorado Medicaid.

Staff attending the Colorado Medicaid drug utilization review committee of Colorado Medicaid.

(Denver) — A state board recommended Tuesday night that more needy Coloradans receive potentially curative treatments for hepatitis C.
But the board stopped short of recommending that the treatments — new drugs that have been shown to have a 90 percent cure rate — be extended to all Coloradans on Medicaid. And that means the American Civil Liberties Union may file a federal lawsuit against the state to force it to provide treatment to everyone.
“It’s not just the right thing to do,” Mark Silverstein, the legal director for the ACLU in Colorado, said at Tuesday’s meeting. “It’s also what’s legally required.”

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Members of the Colorado Medicaid drug utilization review committee

The recommendation came after more than two hours of debate by Colorado’s Medicaid Drug Utilization Review Board, which provides guidance for how the state should provide medication to needy patients. A final decision on the hepatitis C treatments ultimately will come next month from the state Department of Health Care Policy and Financing.
Hepatitis C is a virus that attacks the liver and can lead to prolonged illness and death. Starting in 2011, federal authorities began approving new antiviral drugs for hepatitis C that were seen as breakthroughs with low side effects and high cure rates. There is one hitch: They’re expensive.
Because of the cost, the state pays for the breakthrough drugs only if a patient is in the final two stages of liver damage, known as F3 and F4. The state has so far spent $26.6 million treating 326 hepatitis C patients. Private health insurance and Medicare cover the drug for all hepatitis C patients.
The review board on Tuesday recommended that the state cover the new drugs for all Medicaid patients at a lower stage of liver damage, F2. The board also said the state should cover the drugs for all women at any stage of liver damage who are of child-bearing age — to prevent transmission of the disease to newborn children.
But those recommendations were not without debate.
Supporters of expanding access presented an economic analysis Tuesday that argued Colorado would save money in the long run by curing all hepatitis C patients early in their infection and eliminating the treatment costs later.
“I think the investment now makes sense down the road,” said Dr. Jim Regan, a board member.
But others worried whether the state could afford the initial investment. There are more than 9,000 hepatitis C patients on the state’s Medicaid rolls, but it’s unknown how many would use the new drugs or how much should be budgeted each year to provide them.
“If resources were unlimited that would absolutely be ideal,” Dr. Kerstin Froyd, another board member, said of covering all patients. “But they are not.”
The ACLU’s Silverstein, meanwhile, said federal law requires the state to provide Medicaid patients with all medically necessary care — which he said the new hepatitis C drugs are. If the state does not provide the drugs to all patients, he said the ACLU would probably file a federal lawsuit.

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