AIDS Institute Calls on Medicaid to Stop Using Price of Hep C Drugs as Excuse

Today, The AIDS Institute sent a letter to Seema Verma, Administrator of the Centers for Medicare and Medicaid Services, urging her to enforce Medicaid law and compel states to lift their restrictions on hepatitis C drugs. In the letter, The AIDS Institute claims that the price of the drug, which can cure people within eight weeks, cannot be used as an excuse to restrict access.

"States' continued false statements about the price of the cure and its impact on their budgets inject untruths into the debate on drug pricing, while distracting from the fact that people who need treatment are being kept from it," writes The AIDS Institute's Deputy Executive Director Carl Schmid.

Contrary to treatment guidelines that call for the treatment of all people living with hepatitis C, most states limit patient access by only providing the drugs to their sickest patients. Currently, 31 states plus the District of Columbia restrict access to hepatitis C drugs to people with moderate liver scarring, 13 of these states require people to have severe liver fibrosis. Thirty-eight states have some form of sobriety from drugs and/or alcohol requirement while others have instituted prescriber requirements.

In 2015, CMS issued a State Notice warning states they cannot restrict access to FDA-approved hepatitis C drugs for non-medical reasons. Since then, some states have increased access to the curative drugs, but mainly due to litigation or the threat of litigation.

States and others frequently cite the original list price of the drugs as an excuse to limit access. However, in the letter The AIDS Institute writes, "prices have actually dropped tremendously over the past several years. Multiple new treatments with lower list prices have been approved, creating a very competitive market in which states and other purchasers are able to receive substantial discounts."

The latest approved drug has a list price of only $26,400 for an 8-week course of treatment. Given the automatic 23 percent rebate off a drug's list price, the cost of curing a Medicaid patient would be at most $20,328. Since Medicaid costs are shared between states and the federal government, the states' portion is much less. Prior to the approval of the most recent drug, Louisiana calculated their share of the cost would be only $8,000.

The AIDS Institute in its letter writes, "By delaying HCV treatment through access restrictions, states are inadvertently fueling new HCV cases and hurting the nation's ability to eliminate the disease."

It continues, "Patients should not have to rely on state-by-state litigation to receive access to FDA approved drugs that can cure them of a life-threatening infectious disease."

The letter concludes by urging CMS to "enforce the State Notice and prevent State Medicaid programs from restricting access to approved HCV drugs for non-medical reasons. In so doing, you can help end this infectious disease."

Hepatitis C is a leading cause of liver cancer and can lead to other serious health issues including liver damage and cirrhosis. More than one third of 3.5 million people in America living with hepatitis C are expected to die from hepatitis C-related complications that could be averted with care and treatment. Every year, approximately 20,000 people in the United States die from hepatitis C and its complications. Hepatitis C attributed deaths now surpass the total combined number of deaths from 60 other infectious diseases reported to CDC. Alarmingly, the current opioid epidemic is spurring an unprecedented increase in new hepatitis C infections -- up nearly 300% between 2010 and 2015.

To read the complete letter to CMS Administrator Verma click here.