Oregon Medicaid Program to End HCV Treatment Rationing in 2019

Allison Inserro

Patients with the hepatitis C virus (HCV) who are on Medicaid in Oregon can expect to receive curative treatment in 2019 without having to wait for liver damage to set in. Despite having the highest rate of HCV mortality, per capita, in the country, the state’s Medicaid program had been rationing the drugs, which cost thousands of dollars.

Pharmaceutical company Gilead Sciences had charged $84,000 for a 12-week treatment of Sovaldi, and it priced another drug, Harvoni, at $94,500. However, Gilead will release a generic version of Harvoni next month, pricing it at $24,000.

It's estimated about 100,000 Oregonians have been infected with the virus and more than 500 die every year, PBS has reported.

The problem was made worse by opioid use disorder, which led to a 20% rise in new infections from 2015 to 2016.

The Oregon Health Authority has estimated that about half of those infected don’t know it. About a quarter of the state’s population is covered by the Oregon Health Plan. The state plans to end the rationing in March 2019, allowing the treatment before patients sustain liver damage.

Providing the drug to everyone with hepatitis C would have likely bankrupted the Oregon Health Plan and led to unaffordable premiums, health officials told the Associated Press.

“It was a complete bank-breaker. There was no way individual insurance plans or governments could afford the pill where it was priced,” said Jennifer Lind, CEO of Jackson Care Connect, a provider of Oregon Health Plan coverage.

Falling prices due to generics will allow more people to get treatment, said Josh Balloch, vice president of government affairs for AllCare Health, another provider of Oregon Health Plan coverage.

Last year, researchers writing in a study published in The American Journal of Managed Care® (AJMC®) called for a national strategy to eradicate HCV from the United States regardless of payer status.

They found that restricting HCV treatment for Medicaid beneficiaries based on one’s state of residence is flawed, and leads to suboptimal treatment outcomes, high patient burden, and excess costs. It also worsens health disparities.

Treating everyone without restriction would lead to a $3.8 billion overall savings in healthcare costs, the authors wrote.

Sustained virologic response rates were 95.9% when everyone is treated, compared with 75.2% under Medicaid restrictions, and there were improved clinical outcomes, including:
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