Politics & Government

Medicaid officials want to expand access to pricey hepatitis C drug

Harvoni, a drug for treating Hepatitis C.
Harvoni, a drug for treating Hepatitis C. Gilead Sciences Inc.

Health care officials in Washington state thought thousands of Medicaid patients would line up to receive a breakthrough hepatitis C treatment that went on the market late last year.

Yet by June, the state had treated only a third as many hepatitis C patients as it had planned for — about 1,200 people.

Now, the state’s Medicaid authority wants to use the $44 million it didn’t spend over the past year to start covering the drug for a wider range of patients, instead of just the sickest ones.

State officials estimate about 75,000 to 100,000 people in Washington have hepatitis C, a blood-borne virus that can cause liver failure or liver cancer if left untreated. Nationwide, many people living with the disease are low-income patients who are eligible for Medicaid, officials said.

The new hepatitis C drug Harvoni cures the disease in most patients within eight to twelve weeks, and without the harsh side effects of previous treatments. Unlike with past regimens, most patients can take a once-daily pill to get results, without the need for additional drugs or injections.

The only problem? The 12-week treatment has a wholesale price of about $95,000 per patient.

Partly due to the high cost of the treatment, the state Health Care Authority has so far been offering it only to low-income hepatitis C patients with the worst liver disease — those with advanced liver scarring or cirrhosis, known as fibrosis stages F3 and F4.

But while state officials expected 3,600 of those patients on Medicaid to seek the treatment between August and June, only one-third that many actually showed up.

Now, the Health Care Authority is recommending that the state also start approving Harvoni for Medicaid patients with only moderate liver scarring, or F2 fibrosis.

The agency is asking the Legislature to approve an additional $33.3 million to expand the new hepatitis C treatment to those patients.

That money, combined with the $44 million the state has on hand from treating fewer patients than expected in the past year, would allow the Health Care Authority to provide the drug to 4,700 additional patients whose liver damage is less severe, agency officials said.

Dr. Daniel Lessler, the chief medical officer for the state’s Medicaid program, said the agency’s request is partly based on changing clinical guidelines for how doctors should administer the latest hepatitis C drugs.

“It really is about looking more closely at what constitutes medical necessity,” Lessler said Friday. “When you look at clinical guidelines that are out there, we are trying to take those into account.”

Two nationwide organizations, the American Association for the Study of Liver Diseases and the Infectious Disease Society of America, recently started recommending that nearly all patients with chronic hepatitis C begin treatment with the new drugs.

The groups updated their guidelines this month to eliminate discussion of how doctors should prioritize which patients to treat. The new guidelines recommend that most patients receive treatment, even if they have only mild liver disease.

Michael Ninburg, the executive director of the Seattle-based Hepatitis Education Project, said paying to treat to more hepatitis C patients will dramatically improve those patients’ lives, while also saving the state money on long-term health care costs.

Those who are treated earlier — when they have only moderate liver damage, for instance — won’t advance to later stages of liver fibrosis when they need twice yearly cancer screenings, Ninburg said.

Treating more people will also help curb spread of the disease, he said.

“From a public health perspective, if you’re treated and cured, you can’t transmit it to others,” Ninburg said.