Learn about hepatitis C, the State of Medicaid Access Report and its authors.
About hepatitis C and treatment access restrictions.
Hepatitis C is the deadliest bloodborne infectious disease in the U.S., affecting approximately 2.4 million Americans, according to the Centers for Disease Control and Prevention, and many of these are Medicaid recipients.
Some state Medicaid programs are restricting access to cures for the virus, which kills more Americans each year than all other bloodborne infectious diseases, including HIV, combined.
For the past several decades, hepatitis C treatment has revolved around painful interferon injections, which are vastly ineffective at managing the epidemic on an individual and public health level. In 2013, curative treatments known as direct acting antiviral agents (DAAs) were introduced to combat hepatitis C – offering cure rates of near 100 percent with minimal side effects.
These curative treatments offer hepatitis C patients an unprecedented chance to live virus-free – and avoid liver failure, cancer-causing cirrhosis, liver transplants, and other costly health complications.
Unfortunately, despite the important individual and public health potential of these cures, many state Medicaid programs have limited access to hepatitis C treatments due to cost concerns. These Medicaid coverage restrictions include:
By limiting the safest and most effective treatments only to patients who satisfy a certain set of requirements, state Medicaid programs have imposed significant barriers to care for millions of Americans enrolled in Medicaid, despite clear guidance from the Centers for Medicare and Medicaid Services (CMS) that such restrictions often violate federal law.
These restrictions also directly oppose treatment recommendations issued by two of the leading medical authorities on hepatitis C, the American Association for the Study of Liver Diseases (AASLD) and the Infectious Disease Society of America (IDSA).
Hepatitis C: State of Medicaid Access is the culmination of work by the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) and the National Viral Hepatitis Roundtable (NVHR) to definitively assess the state of access to DAAs for Medicaid enrollees across America. Through a national report and state-by-state report cards, the project provides an in-depth evaluation of DAA access in each state’s Medicaid program, while highlighting successes in access expansion as well as ongoing challenges.
Requiring prescribers to obtain advance approval before insurance will cover HCV treatment
Restrictions based on a patient’s degree of liver damage or fibrosis level
Restrictions based on a patient’s drug or alcohol use
Based on a prescriber’s specialty or expertise
Based on whether a patient has previously received treatment
Assesses parity between a state’s fee-for-service program and contracted managed care organizations
Additional restrictions to treatment that are less common but may pose severe barriers to care
The National Viral Hepatitis Roundtable (NVHR) is a national coalition working together to eliminate hepatitis B and C in the United States. NVHR’s vision is a healthier world without hepatitis B and C. NVHR’s work is guided and informed by our beliefs and commitment to: Participation, Inclusiveness, Intersectionality, Health Equity, and Stigma Elimination.
The Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) advocates for legal, regulatory, and policy reforms to improve the health of underserved populations, with a focus on the needs of low-income people living with chronic illnesses and disabilities. CHLPI works with consumers, advocates, community-based organizations, health and social services professionals, government officials, and others to expand access to high-quality healthcare; to reduce health disparities; to develop community advocacy capacity; and to promote more equitable and effective healthcare systems. CHLPI is a clinical teaching program of Harvard Law School and mentors students to become skilled, innovative, and thoughtful practitioners as well as leaders in health and public health law and policy.
@2024 HEPATITIS C: STATE OF MEDICAID ACCESS
As of February 2024, 28 states have removed prior authorization for first-time treatment: AK, AZ, CA, CO, CT, DC, DE, FL, HI, ID, IL, IN, KS, LA, MA, MI, MO, NC, NH, NY, OK, OR, PA, RI, TX, VA, WA, WI.