Medicaid review board votes to lift some restrictions on life-saving cures for Vermonters with hepatitis C

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Medicaid review board votes to lift some restrictions on life-saving cures for Vermonters with hepatitis C

Tue, 12/13/2016 - 12:18pm -- tim

Vermont Business Magazine At its meeting on December 6, Vermont Medicaid’s Drug Utilization Review Board (DURB) voted to lift some of the restrictions that currently prevent most Vermont Medicaid patients with hepatitis C from accessing life-saving cures. If the DURB’s recommendation is accepted by Department of Vermont Health Access Commissioner Steven Costantino, many more Vermonters on Medicaid who have the life-threatening disease will gain access to treatment. According to the CDC, hepatitis C kills more Americans than any other infectious disease and Baby Boomers are most at risk.

Vermont Legal Aid’s Office of the Health Care Advocate and a coalition of organizations sent a letter to the DURB in late October asking the Board to review and remove all restrictions on hepatitis C medications that deny patients access to medically necessary care and cause unnecessary harm to Vermonters. 

Last Tuesday, the DURB voted to stop excluding people from treatment simply because they have used alcohol or drugs within the last six months. The DURB also voted to treat those with a fibrosis score, a measure of the extent of liver disease, of F2. Vermont Medicaid currently requires six months of sobriety, drug and alcohol testing throughout treatment, and a fibrosis score of F3 or F4 to access treatment. The Board left intact the requirement that patients see a specialist in order to get treatment. 

Julia Shaw, a policy analyst with the Office of the Health Care Advocate, said, “We were hopeful that the DURB would lift all the restrictions as other states like Massachusetts and Connecticut have done, and as we believe is required by federal Medicaid law. However, this is an important step in the right direction. We are very happy that the DURB lifted the sobriety requirement, which is particularly arbitrary and punitive to people, many of whom are unable to access substance abuse treatment. Ensuring that more patients can access curative treatments for hepatitis C will benefit those individuals greatly and will help prevent new infections.” 

“We’re pleased that the DURB voted to revisit the issue within the next six months to consider expanding access further,” Shaw added. “Federal courts, national medical guidelines, and other state Medicaid agencies have recognized that treatment of every patient with hepatitis C is the standard of care. There is simply no medical reason for Vermont to withhold access to this cure.” 

“Commissioner Costantino acknowledged in remarks last week that those who have hepatitis C should have the opportunity to be cured of hepatitis C – and that it’s morally the right thing to do. We’re hopeful that he will not only accept the DURB’s recommendations, but also move as quickly as possible to make treatment available to every Vermonter who needs it,” Shaw said. 

The coalition includes the ACLU of Vermont, Vermont CARES, the Prisoners’ Rights Office, AIDS Project of Southern Vermont, the HIV/HCV Resource Center, and the Vermont People with AIDS Coalition. The Vermont Medical Society and four individual health care providers also sent letters supporting the coalition’s request and emphasizing that the current restrictive criteria are not consistent with current standards of care. 

The Office of the Health Care Advocate (HCA) helps Vermont consumers with a broad range of problems and questions related to health care services and health insurance. The HCA acts as a voice and advocate for consumers in health care policy matters before the Vermont legislature and government agencies that oversee insurance and health care programs. The Office of the Health Care Advocate is a project of Vermont Legal Aid. 

CDC Report

Deaths associated with hepatitis C reached an all-time high of 19,659 in 2014, according to surveillance data released in May 2016 by the Centers for Disease Control and Prevention (CDC).

A second CDC study, published online in Clinical Infectious Diseases, shows that annual hepatitis C-related mortality in 2013 surpassed the total combined number of deaths from 60 other infectious diseases reported to CDC, including HIV, pneumococcal disease, and tuberculosis. Further, both studies use data from death certificates, which often underreport hepatitis C, so there likely were even more hepatitis C-related deaths than these numbers suggest.

The greatest hepatitis C burden falls on baby boomers – those born from 1945 to 1965 – many of whom have unknowingly been living with the infection for many years. According to a study published in The Lancet Infectious Diseases earlier this year, many baby boomers were infected during medical procedures in the years after World War II, when injection and blood transfusion technologies were not as safe as they are today. Without diagnosis and treatment, they increasingly develop liver cancer and other life-threatening hepatitis C-related diseases, and they may unknowingly transmit the disease to others.

“Why are so many Americans dying of this preventable, curable disease?” asked Jonathan Mermin, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “Once hepatitis C testing and treatment are as routine as they are for high cholesterol and colon cancer, we will see people living the long, healthy lives they deserve.”

The surveillance data released today also point to a new wave of hepatitis C infections among people who inject drugs. Acute cases of hepatitis C infection have more than doubled since 2010, increasing to 2,194 reported cases in 2014. The new cases were predominantly among young, white individuals with a history of injection drug use, living in rural and suburban areas of the Midwest and Eastern United States.

“Because hepatitis C often has few noticeable symptoms, the number of new cases is likely much higher than what is reported. Due to limited screening and underreporting, we estimate the number of new infections is closer to 30,000 per year,” said John W. Ward, M.D., director of CDC’s Division of Viral Hepatitis. “We must act now to diagnose and treat hidden infections before they become deadly and to prevent new infections.”

Addressing viral hepatitis risk among people who inject drugs is an important public health priority and a key concern for CDC. CDC recommends that comprehensive prevention programs be implemented to avert drug-related hepatitis C transmission. These prevention programs should include regular testing for hepatitis C (as well as hepatitis B and HIV); rapid links to medical care for people who test positive; and access to substance abuse treatment, sterile injection equipment, and other services.

About 3.5 million Americans are currently living with hepatitis C and roughly half are unaware of their infection. CDC and the U.S. Preventive Services Task Force recommend one-time hepatitis C testing for everyone born from 1945 to 1965 and regular testing for others at high risk. Once diagnosed, patients can take advantage of new, highly effective treatments that can cure the vast majority of infections in two to three months and take other steps to protect their health.

Source: Vermont Legal Aid 12.13.2016. Vermont Legal Aid (VLA) is a non-profit law firm that provides legal advice and services to individuals and families throughout Vermont who are facing a civil legal problem that threatens their rights, shelter, job, health or well-being. VLA began serving clients in 1968.