What we're reading, December 28, 2015: patients fight for Medicaid coverage of expensive hepatitis C treatment, Express Scripts develops programs to protect insurer's from pricey new drugs, and Republicans divided over Medicaid expansion.
Individuals are pushing back at states that are restricting access to curative treatment for hepatitis C, citing cost reasons. Patients in Indiana—one of 34 states where Medicaid refuses to pay for the $95,000 Harvoni unless there’s proof of liver damage—have filed a class action lawsuit to gain access to the pill and ensure Medicaid covers for it, according to a report by the National Public Radio.
By developing optional programs that include newer expensive drugs, Express Scripts is protecting its clients and their budgets from going topsy-turvy, reports AIS Health. With the Hepatitis Cure Value and Cholesterol Care Value Programs in place, the benefit manager is planning to unveil the Oncology Care Value Program and the Inflation Protection Program come January 2016. With an initial focus on prostate cancer, lung cancer, and renal cell carcinoma, patients covered by participating plans will receive “clinically appropriate and cost-effective medication for a specific indication,” according to Express Scripts senior vice president, Clinical, Research & New Solutions, and Chief Innovation Officer Glen Stettin, MD.
Republicans are divided over the Affordable Care Act (ACA), especially when it comes to Medicaid expansion in the states. According to The New York Times, Republican state governors who want to expand the reach of the ACA within their state are facing grief from Republican members in Congress who do not believe the law holds credibility. While Republican governors in Arizona, Arkansas, Indiana, Iowa, Michigan, Nevada, New Jersey, New Mexico, and Ohio, have expanded Medicaid, governors of South Dakota, Tennessee, and Utah are working towards it.