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States take action on hepatitis C drugs

Update on state responses to hepatitis C medication access.

Message received. That would seem to be the case regarding the guidance letter the Centers for Medicare & Medicaid Services sent to states about hepatitis C drugs for Medicaid beneficiaries, which was explored in a previous DRG blog post.

Since CMS sent the guidance letter in November 2015, and with some states being sued or facing lawsuits over the availability of HCV drugs for Medicaid beneficiaries, some states have eased or removed restrictions for drugs such as Sovaldi and Harvoni. These drugs are a cure but cost around $84,000 and $100,000, respectively, for a 12-week course of treatment. That cost could break the budgets of Medicaid programs if all HCV patients were to receive treatment at that cost.

In fact, when Sovaldi entered the market in 2014, just 2 of 26 managed Medicaid plans Decision Resources Group surveyed reported an operating loss in the first and second quarters directly because of HCV drug spending. By the third quarter, the percentage of plans reporting losses from HCV drugs had jumped from 8 percent to 23 percent and hit 27 percent in the fourth quarter. This likely was attributable to more patients and healthcare providers being aware of drugs Sovaldi and Olysio, which costs more than $66,000 for a 12-week treatment. Half of pharmacy directors and medical directors for the surveyed Medicaid managed care organizations were concerned about their MCOs being able to continue participating in the Medicaid program due to the costs of HCV drugs (2015 Access & Reimbursement report [formerly Physician & Payer Forum] on HCV by Decision Resources Group).

Read Full Article: States take action on hepatitis C drugs – DRG Blog, Health Reform – DRG

Read Full Article: States take action on hepatitis C drugs – DRG Blog, Health Reform – DRG

The health and medical information on our website is not intended to take the place of advice or treatment from health care professionals. It is also not intended to substitute for the users’ relationships with their own health care/pharmaceutical providers.

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