New York Said to Probe Insurers Over Hepatitis C Drugs

  • State attorney general probes limited access to treatments
  • Gilead, AbbVie drugs cost about $1,000 a pill before discounts

The New York state attorney general has asked 16 health insurance companies for information on their coverage of hepatitis C treatments, amid concerns that some companies are restricting coverage of the expensive medications, according to a person familiar with the investigation.

Several health insurers, including Aetna Inc. and EmblemHealth Inc., confirmed they were part of the probe. Attorney General Eric Schneiderman’s office has issued subpoenas to the insurers, also including Anthem Inc., requesting documents explaining how they make decisions on who to cover or not, said the person, who declined to be identified because the matter wasn’t fully public.

The hepatitis C medications, made by Gilead Sciences Inc. and AbbVie Inc., have been controversial for their price. While the drugs typically cure a patient of the virus in 12 weeks, their list prices are about $1,000 a pill, or about $84,000 for a course of treatment. Insurers then negotiate discounts with the manufacturers. Some insurers have limited access to the drugs, restricting them to the sickest of patients, saying even with discounts they can’t afford the drug.

Expanded Coverage

Anthem, which operates the Empire Blue Cross Blue Shield insurance company, said it recently expanded coverage of the hepatitis drugs.

“After several months of ongoing clinical review of the medical evidence and safety concerns surrounding hepatitis C treatments, coverage for Empire Blue Cross Blue Shield employer and individual health insurance plans was expanded for six of the newer oral treatments effective Dec. 7, 2015,” Anthem spokeswoman Jill Becher said in an e-mailed statement.

Aetna and Emblem confirmed that they received subpoenas and declined to comment further. Northwell Health, the hospital system formerly known as North Shore-LIJ, said that its insurance unit, CareConnect, got a subpoena.

Cigna Corp. and UnitedHealth Group Inc. didn’t comment. The probe was first reported Wednesday by the Wall Street Journal.

Leslie Moran, a spokeswoman for the New York Health Plan Association, an industry group, said in an e-mail that the scope of the subpoenas was too extensive.

“We feel the Attorney General’s subpoena is overly broad and does not take into account evolving guidance related to these new therapeutic classes of drugs. Moreover, it does not take into consideration the impact of excessive and unsupported pricing of these drugs -- which has a negative impact on affordability of coverage.”

Medicaid Coverage

Medicaid, the U.S. health program for the poor and disabled, has particularly high rates of rejections for patients seeking hepatitis C drugs. In a study of more than 2,000 patients between October 2014 and March 2015, disease management firm Trio Health found that Medicaid was denying prescriptions for at least 30 percent of patients. In comparison, at least 14 percent of patients were unable to start on treatment when covered by commercial insurers.

Trio Health found a huge variance from state to state. In Tennessee, 24 of 25 Medicaid patients weren’t able to start on a Gilead or AbbVie regimen after getting a doctor’s prescription, while in Connecticut, all 16 Medicaid patients surveyed were able to obtain treatment.

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