Health Care

Advisory board urges expanded access to hepatitis C drugs

An advisory board says the state should make it easier for Vermont’s Medicaid patients to get access to expensive prescription drugs that treat hepatitis C.

The Medicaid Drug Utilization Review Board, an advisory panel, voted Dec. 6 to lift certain restrictions that make it harder or impossible for some Medicaid patients with the disease to get specialty drugs.

The Department of Vermont Health Access, which administers Medicaid, will need to decide whether to accept the board’s changes. The department has historically set strict restrictions on the drugs because of their high cost.

Steven Costantino, the commissioner of the Department of Vermont Health Access, said in February the cost of the drugs is “a critical concern” to the state from a financial perspective and “kind of an ethical dilemma” for people running state Medicaid programs.

He was not available for comment this week.

In 2015, the state spent $11.9 million to buy the hepatitis C drug Harvoni, and it spent $3.3 million in 2014 on Sovaldi, another hepatitis C drug, according to a VTDigger investigation. While the state eventually received rebates for both of those drugs, they are widely considered some of the most expensive drugs on the market.

But the board says the Department of Vermont Health Access should pay for more Medicaid patients to get the hepatitis C drugs, including patients who have stage 2 liver disease. Currently, the department restricts the drugs to only people whose liver disease has progressed to stage 3 or 4, who often already have irreversible liver scarring.

The department also says patients can get the hepatitis C drugs only if they have not used drugs or alcohol for the six months before treatment and make themselves subject to drug testing throughout their treatment. The board voted against that restriction too.

The vote follows more than a year of advocacy from a coalition of organizations led by Vermont Legal Aid’s Office of the Health Care Advocate. The coalition includes the American Civil Liberties Union of Vermont, the Prisoners’ Rights Office and the Vermont People with AIDS Coalition.

In November 2015, after federal regulators at the U.S. Centers for Medicare and Medicaid Services said Medicaid patients should be allowed to get hepatitis C drugs, the Office of the Health Care Advocate sent a letter to the Department of Vermont Health Access asking for the restrictions to be lifted.

The department responded in December 2015: “We believe our actions regarding the limitations of hepatitis C medication are proper. We will, as required by law, continue to monitor the drug’s usage, including a case-by-case determination” when patients request to use the drug.

Julia Shaw, a policy analyst for the Office of the Health Care Advocate, said the state and society in general are tolerating limits on treatment for people with hepatitis C because the disease still carries a stigma.

Hepatitis C is a blood-borne virus often transmitted sexually or through sharing heroin needles, according to the U.S. Centers for Disease Control and Prevention. In the long term, hepatitis C causes liver damage.

“From our perspective, we don’t punish people for their other behaviors,” Shaw said. “We don’t withhold treatment for lung cancer because someone smokes, or we don’t withhold treatment for diabetes because somebody didn’t eat right or didn’t exercise.”

“I don’t think people would tolerate this type of rationing of medication based on the cost for cancer — pretty much for everything else,” Shaw said. “The only explanation is because it’s a stigmatized disease.”

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Erin Mansfield

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  • edward letourneau

    Sure we aren’t spending enough to support drug users. Lets take the money from Medicaid patients and help the people we see more of.

  • Dmitry Ozman

    All the end of year discussions regarding paying our sales and use taxes for online purchases now seem really amusing. No way will I pay a single cent voluntarily after reading this.

  • Darcy Canu

    Let me say up-front that I am NOT a Medicare recipient. I AM a subscriber to BCBS through VHC. Having struggled with life-long anxiety and depression, which many know is common, but still a ‘stigmatized’ disease for some strange reason, why should I stand by and watch Hep.C patients, who have probably indulged in ‘risky’ behavior, get the treatment they need, when I do well on a certain top tier medication, but which is completely unaffordable to me, at 200.00 monthly o o p?
    It seems that there should be some way that medication that really works, for the first time, in my case, years, should be available without the burden of tremendous cost that would have me choosing between meds, or food. Tell me how the little person is going to fare when this type of inequity is apparent and the only difference between me and the others is that I am not a Medicare recipient. Maybe I should quit my job.

  • Mary Martin

    Not all cases of Hep C are from drug use. I know a young woman who contracted it while helping out in New Orleans after Katrina. If the drugs are too expensive, that should be the fight. Pharma is BIG business and huge profits.

  • Louis Meyers, M.D.

    I agree with Ms. Martin’s comment. There is no reason these Hepatitis C antivirals should be this expensive. There are several similar products which have been approved by the FDA, but there seems to be little or no price competition. The state government should use the limited purchasing power we have to negotiate the best deal possible. The financial cost of advanced
    liver failure is considerable…the human cost in suffering is far more.

  • Jim Candon

    This is more evidence of the cost of drug abuse to our state. The cost is extensive not onlly in millions we spend in tax dollars for treatment but the other social costs in crime and child neglect etc. This all began when the state ignored its responsibility to safeguard the supply and distribution of dangerous Rx drugs resulting in the widespread abuse of Rx painkillers which then morphed into heroin abuse. The media and the politicians have hidden that sad history from the “conversation” thus far.

  • Gerry Silverstein

    “From our perspective, we don’t punish people for their other behaviors,” Shaw said. “We don’t withhold treatment for lung cancer because someone smokes, or we don’t withhold treatment for diabetes because somebody didn’t eat right or didn’t exercise.”

    The treatment for Hepatitis C infection is NOT a vaccine. The drug treatment eradicates the viral infection, and has a terrific success rate. That said, after completing a drug regimen and being “cured”, a person can and will be re-infected if they are re-exposed to the Hepatitis C virus, such as through iv drug use.

    Considering the cost of the drugs, and considering the $1.7 billion dollar cost of Medicaid in Vermont (covering 1 in every 3 citizens) that has been responsible for 90% of budget shortfalls in Vermont the last 2 years, it is reasonable for the State to assess whether risk behavior (such as iv drug use) has stopped and will not resume after treatment.

  • Katharine Hikel, MD

    Go, Erin!

    Heptatitis C is increasing in incidence – now over 2% in the US (that’s over 4 million people). Transfusions before 1990 have been implicated; the virus is also spreadable by sexual contact, shared needles, the usual body-fluids routes (including hospital-borne routes).

    The worse news is that the price of the antiviral treatment is driven up by a yuuuge lawsuit between Big Pharma empires: http://www.reuters.com/article/gilead-sciences-merck-co-verdict-idUSL1N1EA28S

    One might diagnose the current chronic raging-hormone epidemic here. You know the one I mean.

    Thank you, Erin! Keep digging!