Washington Ordered to Cover Hepatitis C Drugs During Lawsuit

  • Hepatitis C drugs cost as much as $94,500 before discounts
  • Washington verdict may set precedent for treatments nationally

Washington’s Medicaid program must pay for expensive hepatitis C treatments like Gilead Sciences Inc.’s Harvoni ahead of a trial to determine whether the state can exclude the medicine from being covered.

Two patients sued the state health authority which runs the program in February for not covering treatment for patients with hepatitis C, a progressive disease that attacks the liver, because they weren’t sick enough. U.S. District Court Judge John Coughner said Friday that the state had to remove its coverage restrictions while the case is decided.

Many state Medicaid programs, which provide insurance to the poor, have similar restrictions over which patients can receive the drugs that can cost $94,500 before discounts. Lawyers for the patients suing in Washington said in court papers that those restrictions were put in place to save money have no basis in treatment guidelines.

If Washington "were to pay for hepatitis C treatment for all Medicaid clients infected with hepatitis C, the cost would be three times the current total pharmacy budget," MaryAnne Lindeblad, the state’s Medicaid director, wrote in a letter to senators investigating the pricing of the drugs in September 2015.

At least one other similar case is pending in Indiana. If one of the cases succeeds, it could set a legal precedent nationwide that forces Medicaid programs to cover the drugs. Medicaid patients and prisoners have disproportionately high rates of the disease, which can be spread through contaminated drug needles, compared to the wider population.

The case is B.E. v. Dorothy F. Teeter, 16-cv-00227, U.S. District Court, Western District of Washington (Seattle).

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