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Tuesday, May 31 2016

Full Issue

Federal Judge Orders Medicaid To Pay For Hepatitis C Drugs In Wash. Ahead Of Trial

The drugs can run nearly $100,000 for the full treatment, and Washington -- as well as other states -- have held off covering them until patients are quite sick. Washington officials say covering all cases of hepatitis C could triple the state's Medicaid pharmacy bill.

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. (Spalding, 5/31)

A federal judge has ordered Washington state’s Medicaid provider to cover expensive hepatitis C drugs for all patients with the liver-destroying disease, not just those who are sickest. U.S. District Court Judge John C. Coughenour granted a preliminary injunction Friday that forces the state Health Care Authority (HCA) to halt a 2015 policy that restricted access to the drugs based on a fibrosis score, a measure of liver scarring. (Aleccia, 5/28)

As state officials weigh the legal, moral and economic issues for treating Medicaid beneficiaries diagnosed with a hepatitis C liver infection, Pennsylvanians can be assured of one thing: It’s going to be expensive. In a span of two years, the state Department of Human Services’ Medicaid program has seen its bill for hepatitis C drug treatment jump from $33.7 million to $138.1 million. (Twedt, 5/31)

In other Medicaid news —

Kansas health care providers will urge federal officials to reject Gov. Sam Brownback’s proposed Medicaid cuts and may challenge them in court. The recently announced cuts would reduce state expenditures for KanCare, the state’s privatized Medicaid program, by $56.3 million and trigger a loss of approximately $72.3 million in federal funds. Combined, the managed care organizations that administer the $3 billion KanCare program and the health care and service providers they have contracts with would be forced to absorb more than $128 million in cuts. (McLean, 5/27)

Dee Martin may wake up on Jan. 1 and find herself in a whole different state. South Carolina and North Carolina have redrawn the border between the two states with GPS technology that allows them to confirm the boundary lines established under an English king in the 18th century down to the centimeter. ... But the biggest problem may come through the homebound health care she gets for her 89-year-old husband. The provider doesn't serve North Carolina and that state's Medicaid may not pay for the service even if they change doctors and nurses. (Collins and Robertson, 5/29)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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