Federal Court rules against Health Care Authority’s policy on Hepatitis C meds

Today, federal district court Judge John C. Coughenour granted a preliminary injunction ordering the Washington State Health Care Authority to cover treatment for Hepatitis C for all state Medicaid enrollees without exclusion based on fibrosis score.

Under its February 25, 2015 HCV treatment policy, the state Medicaid agency could limit access to costly anti-viral medications such as Harvoni, manufactured by Gilead Sciences, to patients with irreparable liver damage due to Hepatitis C. Patients sued the agency over this policy.

Plaintiff attorneys argued that making patients wait through a “monitoring” period violated clinical guidelines of the American Association for the Study of Liver Diseases (AASLD) and contradicted the Nov. 5, 2015 CMS Notice “Assuring Medicaid Beneficiaries Access to Hepatitis C Drugs.”

The HCA stated in the court document that the injunction would “double the State’s Medicaid outpatient Pharmacy budget and cause them to reduce Medicaid enrollments, benefits, or provider rates to compensate for the increased expenditure in HCV treatment.”

In his ruling Judge Coughenour stated, “Plaintiffs argue that the injunction is in the public interest because it seeks to bar a public agency from violating “existing law.” The Court agrees…Furthermore, as Plantiffs emphasize, an injunction is an important matter for the public because it deals with treatment and management of a communicable disease.”

“Medicaid programs across the country should consider Judge Coughenour’s Order and change their practices before they also get sued,” said Kevin Costello of the Center for Health Law and Policy Innovations at Harvard Law School. “Rationing policies like the one used by the Washington Health Care Authority are in place in dozens of states across the country. All of those policies are likely improper as well.”