VPR | December 2, 2016

For Some Vermonters Suffering From Hepatitis C, Life-Saving Cure Is Out Of Reach

Health advocates are challenging a Vermont Medicaid policy that has restricted curative treatment for hepatitis C only to patients with advanced liver problems. And while state officials say they’re open to changing the policy, they say offering treatment to all low-income Vermonters could cost taxpayers as much as $25 million over two years. ...

Julia Shawis the health care policy analyst in the Office of the Health Care Advocate, which is administered by Vermont Legal Aid. Shaw says the policy is tragically misguided.

“Because hepatitis C is such a serious illness and because our Medicaid program is systematically denying a large portion of the population access to a curative treatment for something so serious,” Shaw says.

Here’s the issue for the potentially hundreds of Medicaid beneficiaries like the Patient in this story: Doctors assess liver damage using what’s known as a Metavir fibrosis score. It basically measures the amount of scarring on the liver. And under Vermont Medicaid’s prior-authorization policy, beneficiaries don’t get the cure until they have a score of F3 or higher, which, according to Shaw, “basically requires a patient with Hepatitis C to have significant liver damage before they’re able to be treated.” ...

With the abundance of medical evidence pointing to the benefits of early treatment, Shaw says the Vermont Medicaid policy is indefensible.

“Denying patients access to something with such clear benefits is immoral, it’s illegal, and it shouldn’t be happening,” Shaw says. ...

Vermont Legal Aid is also trying to get the state to change other elements of its hepatitis C treatment policy. Existing policy requires patients to see a specialist, a requirement Shaw says creates a too-high hurdle for patients in rural areas of the state.

The state also requires patients to remain drug- and alcohol-free for six months before they begin treatment.

Shaw says people using drugs or alcohol are statistically as likely to benefit from the treatment as people who abstain. And she says the requirement might allow the virus to remain in populations at highest risk of passing it on to others. ...

The state’s Drug Utilization Review Board is meeting next week to consider a rule change.