Medicaid Plans Look to States for Help with Expensive Hepatitis C Drug

Medicaid managed-care plans are looking to state officials for help as they face massive outlays for the new hepatitis C drug Sovaldi, which costs $84,000 for a 12-week course of treatment.

Medicaid managed-care plans are looking to state officials for help as they face massive outlays for the new hepatitis C drug Sovaldi, which costs $84,000 for a 12-week course of treatment.

The companies that administer the Medicaid plans are eager to raise the matter with state officials and Congress because conversations are beginning now to set the 2015 rates, Jeff Myers, president and CEO of the trade group Medicaid Health Plans of America, said in an April 28 letter to the National Association of Medicaid Directors (PDF). The trade group is asking the Medicaid directors to form a workgroup to tackle the problem.

Plans in some states are considering eliminating coverage for the drug, having Medicaid agencies pay for it above the capitation rate paid to plans, or building the drug into the rates paid by state agencies, Myers said. Medicaid agencies in Louisiana, California, Michigan and Florida have already limited access to the drug based on case-by-case determinations.

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Source: Modern Healthcare