About 46% of Medicaid patients in four northeastern states were denied treatment with new direct-acting antiviral (DAA) drugs, which have been shown to cure more than nine out of ten hepatitis C patients, researchers reported in a new study. These powerful medications include Sovalda (sofoshuvir) and Harvoni (ledinasvir).
By comparison, only 10% of privately insured patients and 5% of Medicare patients were denied treatment said study author Dr. Vincent Lo Re III, an assistant professor medicine and epidemiology in the division of infectious diseases at the Perelman School of medicine at the University of Pennsylvania in Philadelphia.
State Medicaid programs have place stringent pre-approval requirements on the drugs due to their high cost Lo Re explained. A 12-week round of treatment for just one patient can cost as much as $90,000.
However, such tight coverage policies might prove pennywise but pound-foolish. Early treatment of hepatitis C with the new drugs can save billions in health care costs according to another study, published November 23 in the journal JAMA Internal Medicine.
Hepatitis C can do terrible damage to the liver if left untreated, including scarring of the liver and liver cancer, according to the U.S. National Institutes of Health. Serious cases often require a liver transplant. “Medicaid likely will end up spending even more in the long run as hepatitis C patients grow sicker and require more drastic treatment, “said Tom Nealon, chief executive officer of the American Liver Foundation.
About 3.2 million Americans are estimated to have chronic hepatitis C infection, according to background information provided in the JAMA report.
The most common reasons for denial by Medicaid were “insufficient information to assess medical need” (48%), “lack of medical necessity” (31%) and a positive alcohol/drug screen (4%).
The U.S. Centers for Medicare and Medicaid Services (CMS) has asked all states to reevaluate their restrictions. They also have asked the drug companies involved to document the cost of the medications. I think this is just posturing to make it appear that the CMS is actually interested in solving this dilemma.
The cost of these medications is high in the rest of the world, about $2000 for six months of treatment, but obviously much less than the average in the U.S. at $84,000 for the same time period.
This is price gouging. There are only a couple of DDA drugs on the market so competition is non-existent. If you sell water, ice or gasoline at inflated prices after a natural disaster, you can be prosecuted for a felony. These drug companies are using peoples lives and health to extract outrageous amounts of money from our health care system.
The Bottom Line:
The states are worried that these high cost drugs will overwhelm their health care budget. I am concerned cost overruns for drugs and surgery will overwhelm our entire economy. It won’t take a zombie apocalypse to end life as we know it, just greedy drug companies.