Change In Vt. Medicaid Policy Could Improve Access To Live-Saving Hepatitis C Treatment

Dec 16, 2016

A change in Vermont’s Medicaid policy could soon deliver potentially life-saving treatment to many low-income patients with hepatitis C. But the reform won’t come cheap, and even with the changes, many patients still won’t have access to the costly cure.

The anti-viral drugs that cure hepatitis C can cost as much as $150,000 per patient. Those high costs led to a Medicaid policy in Vermont that restricts treatment only to patients with advanced liver scarring.

But last week, the state’s Drug Utilization Review Board voted to change the policy. And the drugs will now be available to people with damage scores of F2 or worse. The policy previously reserved treatment only for patients with scores of F3 and F4, which denotes severe liver damage.

“A score of F2 indicates that the liver ... there already is some damage beginning there, but it is less severe damage than Medicaid had required previously,” says Julia Shaw, a policy analyst with the Office of the Health Care Advocate. 

Shaw’s office had also been pushing the board to lift a requirement that patients be drug- and alcohol-free for six months prior to receiving treatment. Shaw says there’s no medical evidence that even injection drug users suffer higher rates of re-infection than people who remain abstinent. 

The board agreed.

“It was a really discriminatory requirement that wasn’t based on medical evidence, so we’re really happy with that result,” Shaw says.

"I don't think anybody disagrees with the policy. It’s identifying the funds." — Steven Costantino, Department of Vermont Health Access commissioner

The Office of the Health Care Advocate at Vermont Legal Aid had called for the Drug Utilization Review Board to open up treatment for all hepatitis C patients, even those without any discernable liver damage. 

“We believe that all patients with hepatitis C should have access to this important cure, and we don’t believe that reducing the fibrosis requirement to F2 goes far enough,” Shaw says.

That more extensive coverage would add as much as $25 million to state Medicaid costs annually. And even under the less aggressive policy the Drug Utilization Review Board approved last Tuesday, Vermont could see Medicaid costs spike by $7 million a year.

Steven Costantino, commissioner of the Department of Vermont Health Access, says he’ll take steps to institute the reforms voted on by the board.

“I believe the review was based on clinical evidence that the treatment has tremendous benefits for people in the F2 stage,” Costantino says. 

But Costantino says addressing the fiscal impact on an already over-stretched Medicaid budget won’t be easy.
 “They still have to identity the funds, that’s really I think the last step in this. I don’t think anybody disagrees with the policy. It’s identifying the funds,” Costantino says. 

Costantino says the task of figuring out how to make the numbers work will fall to the administration of Governor-elect Phil Scott.