Wolf Administration Announces Medicaid Policy Change for Individuals Suffering from Hepatitis C Virus
The Department of Human Services (DHS) has announced changes to the state’s Medicaid (MA) policy to expand coverage of life-saving drugs to treat Hepatitis C (HCV) virus. Beginning on July 1, the Department will begin phasing in coverage for individuals who have liver function test scores of “F1” or “F0”.
HCV test scores are categorized by the severity of the disease from F0 through F4, with F0 being the least severe form of the disease and F4 being the most severe. Prior to this announcement, the department provided health care coverage through Medicaid for individuals whose scores ranged from F2 through F4 unless they also had other clinical complications.
“Today’s announcement means that thousands of vulnerable Pennsylvanians will soon have easier access to pharmaceuticals that can cure HCV,” said DHS Secretary Ted Dallas. “Moving forward, the severity of this disease can no longer prevent all MA beneficiaries from getting access to treatment if they need it.”
The policy change follows the clinical recommendations presented by the department’s Pharmacy & Therapeutics Committee.
Under the new policy, the department will authorize the drugs for beneficiaries with test scores of F1 starting on July 1, 2017 and will authorize treatment for beneficiaries with scores of F0 starting on January 1, 2018. Adding F0 and F1 will ensure that all qualified individuals with HCV will have access to pharmaceuticals that can now cure this disease.
HCV is a communicable disease that causes chronic inflammation throughout the body and can lead to serious liver damage, cancer, and death. At least 20,000 people in the United States die each year due to liver disease caused by HCV, making it the deadliest communicable disease in the country. Individuals with HCV can suffer from diabetes, lymphoma, fatigue, joint pain, depression, and other diseases even before reaching the advanced state of the disease.
“Pennsylvania’s new approach will directly improve the lives of many of our clients – some of Pennsylvania’s most vulnerable citizens,” said Laval Miller Wilson, Executive Director of the Pennsylvania Health Law Project (PHLP).
“I would like to thank Laval, Amy Hirsch, Kevin Costello and everyone at PHLP, Community Legal Services, Kairys Rudovsky, Messing & Feinberg, and Center for Health Law & Policy Innovation of Harvard Law School who worked with the department on finding a path forward,” said Secretary Dallas. “Their help has been invaluable throughout the process and been a critical component of being able to make today’s announcement.”