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May 19, 2021

Press Release: New Report Shows Discriminatory Sobriety Restrictions Undermine Public Health Efforts to Eliminate Hepatitis C

The Hepatitis C: State of Medicaid Access National Progress Report shows that hepatitis C patients have better access to treatment, but that sobriety restrictions remain particularly harmful amid the ongoing opioid epidemic.

Washington, D.C. (May 19, 2021) – The Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) and the National Viral Hepatitis Roundtable (NVHR) today released a new progress report detailing the changes to hepatitis C treatment access in Medicaid programs since first publishing an analysis in 2017. The Hepatitis C: State of Medicaid Access May 2021 National Progress Report (Progress Report) demonstrates that while there is better access to hepatitis C (HCV) treatment today, discriminatory practices persist in some state Medicaid programs. In particular, sobriety restrictions continue to undermine public health efforts to eliminate hepatitis C in the U.S.  

The State of Hepatitis C has since 2017 assessed and graded Medicaid programs in all 50 states plus Puerto Rico and Washington, D.C. according to its overall “state of access” for HCV treatment. The State of Hepatitis C focuses on three of the most significant restrictive criteria that Fee-for-Service Medicaid programs use as methods of rationing access to the HCV cure: 1) fibrosis (liver damage or disease progression required prior to treatment); 2) sobriety (periods of abstinence from alcohol and/or substance use required); and 3) prescriber (prescribing eligibility limited to certain categories of specialist practitioners).

The Progress Report shows that advocacy and litigation have driven improvement to treatment access. Since 2017:

  • 32 states have either eliminated or reduced their fibrosis restrictions;
  • 21 have loosened their sobriety restrictions;
  • 25 have scaled back their prescriber restrictions; and
  • Seven states have removed all restrictions and removed prior authorization for treatment entirely: Washington, Louisiana, New York, California, Indiana, Wisconsin, and Michigan.

The improvement to patient access for hepatitis C treatment is also evident in the fact that there are now 27 states that have an A grade, improved from only 5 states in 2017. In addition, only 4 states currentlyhave a D or F grade, decreased from 27 states with a D or F grade in 2017.

“State Medicaid programs have made tremendous progress in five years in removing barriers to treatment, particularly with fibrosis restrictions. However, discriminatory restrictions remain in several states, and continue to undermine our collective efforts to address both hepatitis C and the growing opioid epidemic,” said Phil Waters, Staff Attorney at CHLPI. “In order to move towards elimination of viral hepatitis, we call on states to drop all remaining restrictions and urge the federal government to hold states accountable for providing non-discriminatory coverage of HCV treatment in the Medicaid program.”

“The sobriety restrictions remain the most pressing and widespread barrier to accessing HCV treatment at a time when the opioid crisis has fostered a new wave of HCV infections among younger people who inject drugs and whose needs are ill-served by sobriety restrictions,” said Adrienne Simmons, Director of Programs at NVHR. “A generation struggling to survive the overdose crisis will face long-term health consequences from HCV if Medicaid policies are not revised to facilitate access to treatment now.”

The State of Hepatitis C continues to hold state Medicaid programs accountable and drive advocacy urging the removal of all treatment restrictions in line with guidance from the U.S. Centers for Medicare and Medicaid Services and the standard of care established by the AASLD/IDSA guidelines. Increasing access to hepatitis C treatment is especially vital as the COVID-19 pandemic has interrupted prevention and treatment services, driving increased urgency around the need to remove barriers to treatment.

For more information about hepatitis C treatment access barriers and to read the full report, please visit www.stateofhepc.org.

April 22, 2021

Press Release: Michigan Improves Access to Hepatitis C Treatment for Medicaid and Healthy Michigan Plan Patients

The Wolverine state removed prior authorization requirements for a preferred hepatitis C medication, increasing access to hepatitis C treatment for more Michiganders.

Washington, D.C. (April 20, 2021) – The Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) and the National Viral Hepatitis Roundtable (NVHR) today applauded Michigan Department of Health and Human Services (DHHS) for removing prior authorizations for a preferred hepatitis C medication. Michigan joins just six other states that do not require prior authorization for hepatitis C treatment, including California, Indiana, Louisiana, New York, Washington, and Wisconsin. Up to 200,000 Michiganders are estimated to be living with hepatitis C, and lifting these restrictions will help increase access to the hepatitis C cure for thousands.

“Michigan has been a leader in removing barriers to hepatitis C treatment for several years, and this next step of removing prior authorizations for preferred treatment will go a long way toward further improving access to hepatitis C care for Michiganders,” said Phil Waters, Staff Attorney at CHLPI. “We encourage all payors and providers to immediately implement policies that eliminate prior authorization and other forms of unduely burdernsome utilization management to help improve individual and public health outcomes, especially amid the ongoing coronavirus pandemic.”

In an effort to eliminate hepatitis C as a health threat to Michiganders, the state recently launched the new “We Treat Hep C” initiative and a state plan on eliminating hepatitis C. The initiative will help raise awareness among at-risk populations for hepatitis C, encourage testing and screening for hepatitis C, and reduce barriers to curative hepatitis C treatment.

“It is encouraging to see states like Michigan develop hepatitis C elimination plans, and as a part of that, improve hepatitis C testing and treatment options. Removing prior authorizations for preferred treatment eliminates one uneccessary hurdle for getting patients the care they need,” said Adrienne Simmons, Director of Programs at NVHR. “With treatments now available that cure hepatitis C, it is unacceptable that patients continue to live with or die from hepatitis C and we look forward to seeing the progress Michigan makes to eliminate the virus.”

The removal of prior authorization for preferred treatment and previous barriers to hepatitis C treatment has improved Michigan’s score on the Hepatitis C: State of Medicaid Access to an A+, joining only a few other states with the top score. This designation is a step forward in the fight to improving patient access to hepatitis C treatment and towards eliminating hepatitis C as a public health threat.

For more information about hepatitis C treatment access barriers, please visit www.stateofhepc.org.

February 22, 2021

Press Release: Wisconsin and Indiana Remove Barrier to Hepatitis C Treatment for Medicaid Patients

The two midwestern states removed prior authorizations for first time hepatitis C treatment, increasing opportunities for 130,000 individuals to be treated and cured of hepatitis C.

Washington, D.C. (February 22, 2021) – The National Viral Hepatitis Roundtable (NVHR) and the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) today applauded Wisconsin Medicaid and Indiana Medicaid for removing prior authorizations for first time treatment for hepatitis C, joining just three other states without prior authorization requirements, including Louisiana, New York, and Washington. Lifting these restrictions will increase access to the hepatitis C cure for approximately 70,000 Wisconsin residents and an estimated 60,000 Indiana residents that are living with hepatitis C.

“Prior authorizations are a modifiable barrier to hepatitis C elimination that ultimately delay care for marginalized communities. Wisconsin and Indiana’s decisions to remove prior authorizations for first time HCV treatment is a vital step to combat rising hepatitis C rates and put the U.S. on a path towards hepatitis C elimination,” said Adrienne Simmons, Director of Programs at NVHR. “Wisconsin and Indiana join New York in removing prior authorizations for hepatitis C treatment, and we look forward to other states doing the same.”

Cases of Hepatitis C, a viral infection that causes liver inflammation and is one of the leading causes of liver disease, have been increasing since 2010 due to the ongoing opioid crisis. Today’s treatment for hepatitis C can cure most people in 8 to 12 weeks. Yet barriers to this treatment persist across the country.

“It is encouraging to see Wisconsin and Indiana remove prior authorization requirements for first time hepatitis C treatment patients and help reduce the threat of further health complications and liver cancer,” said Robert Greenwald, Clinical Professor of Law at Harvard Law School and the Faculty Director of CHLPI. “We encourage all payors and providers to immediately implement the new policies to help improve public health outcomes, especially amid the ongoing coronavirus pandemic.”

Prior authorization is a process whereby health care providers must get advance approval before a payor will decide whether to cover a medication or service. When the State of Hep C first started tracking prior authorization restrictions in state Medicaid programs for hepatitis C treatment in 2017, both Wisconsin and Indiana used criteria to determine whether patients qualified for hepatitis C treatment, such as requiring a period of sobriety or advanced liver damage. However, the midwestern states have steadily been improving access to hepatitis C care for Medicaid beneficiaries and the latest removal of prior authorizations has consequently increased Wisconsin and Indiana’s Hepatitis C: State of Medicaid Access score to A+. For more information about hepatitis C treatment access barriers, please visit www.stateofhepc.org.

November 13, 2020

NVHR and CHLPI Release New Analysis Showing State Policies Limit Progress Towards Hepatitis C Elimination in the U.S.

New research from NVHR and CHLPI demonstrates that states with sobriety restrictions or state policies that restrict harm reduction services are limiting hepatitis C elimination efforts in the U.S.

Washington, D.C. (November 13, 2020) – The National Viral Hepatitis Roundtable (NVHR) and the Center for Health Law and Policy Innovation (CHLPI) of Harvard Law School today published a new analysis of state policies and laws that are harming hepatitis C virus (HCV) elimination efforts in the U.S. The research shows that policies which mandate periods of sobriety prior to hepatitis C treatment and laws that restrict harm reduction services perpetuate stigma associated with drug and alcohol use and discourage people who use drugs or alcohol from seeking HCV testing and treatment.  

“Sobriety requirements and laws that limit harm reduction services restrict access to hepatitis C treatment and deny people who use substances their right to health care. These discriminatory practices not only needlessly endanger patients’ health, but also undermine public health efforts to end the HCV epidemic,” said Dr. Adrienne Simmons, Policy Manager at NVHR. “Policymakers must take action to remove these barriers to treatment, which are not based on scientific evidence.”

Hepatitis C infection rates continue rising in the U.S. despite the availability of highly effective curative treatment, driven primarily by injection drug use as a result of the opioid crisis. Amid this concerning trend, many state Medicaid programs have enacted harmful policies that require severe liver damage or periods of sobriety prior to treatment, or require specialists to treat hepatitis C. Such barriers are often illegal and go against current medical standards of care.

“Limiting hepatitis C treatment access through sobriety requirements not only perpetuates stigma and goes against medical standards of care, but may also violate the Americans with Disabilities Act which prohibits discrimination against persons with disabilities in public services, including people with substance use disorders who are seeking health care,” said Robert Greenwald, a Clinical Professor of Law and the Faculty Director of the Center for Health Law and Policy Innovation at Harvard Law School. “Ending these discriminatory practices is both a health justice issue and a public health issue. In order to eliminate hepatitis C in the U.S., we need to make treatment available to all who need it and remove burdensome barriers to care.”

Fortunately, progress has been made toward eliminating hepatitis C treatment restrictions over the last few years. The new research shows that 74% of Medicaid programs currently impose no documented minimum time period of sobriety prior to authorizing HCV treatment, up from just 41% of programs in 2017. Additionally, those that maintain a sobriety requirement have shortened the sobriety period and no states require a full year of sobriety anymore. However, in many states where sobriety requirements persist, state policies that do not explicitly authorize Syringe Services Program (SSP) operation and laws that criminalize the transmission of hepatitis C also limit the ability to eliminate hepatitis C in the U.S. by 2030. 

NVHR and CHLPI reviewed previously published data detailing 12 states that do not authorize SSPs and 13 states that criminalize the transmission of hepatitis C, and concluded that a majority of those states also mandate sobriety to access hepatitis C treatment through Medicaid. The legal and policy environment in these states discourages people who use drugs from accessing care and allows stigma to persist – including from clinicians – which undermines the ability to prevent the progression of liver disease and to reduce or eliminate the risk of HCV transmission.

The research from CHLPI and NVHR concludes, “delaying and restricting access to care for people who use substances not only allows the health of these individuals to deteriorate, but also undermines public health efforts to end the HCV epidemic.”

To view the full study, please visit http://stateofhepc.org/wp-content/uploads/2020/11/AASLD-Poster-NVHR_CHLPI-2020.pdf.  

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September 21, 2020

New York Increases Access to Hepatitis C Treatment for Medicaid Patients

New York State Medicaid recently removed prior authorization requirements for new patients, increasing opportunities for individuals to be treated and cured of hepatitis C.

September 21, 2020 – The National Viral Hepatitis Roundtable (NVHR), the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI), and the Treatment Action Group (TAG) today applauded New York State (NYS) Medicaid for removing the requirement that new patients receive prior authorization approval for hepatitis C treatment. Additionally, NYS Medicaid will no longer impose sobriety screening requirements, which will help increase access to hepatitis C treatment for 223,700 individuals living with hepatitis C in New York.

“Removing prior authorization requirements is an important step in expanding access to hepatitis C treatment and we look forward to this policy being equally implemented across payors,” said NVHR Policy Manager Adrienne Simmons, PharmD. “By also eliminating the need for substance use screening, NYS Medicaid is removing discriminatory policies that propagated stigma and contradicted the standard of care.”

Prior authorization is a tool used by payors and insurance companies to determine if they will cover a prescribed procedure, treatment or medicine. In many cases, even if a clinician recommends a patient for hepatitis C treatment, Medicaid payors can deny coverage, which can lead to worse health outcomes for patients.

“Prior authorization requirements put payors in control of prescribing decisions, when clinical providers and patients should be making health care decisions together. Removing prior authorizations for first time treatment with direct acting antivirals for hepatitis C will shorten the time from diagnosis to cure and help New York State fulfill our commitment to ending the deadly hepatitis C epidemic,” said Annette Gaudino, Director of Policy Strategy at the Treatment Action Group.

However, current differences in coverage among fee-for-service and managed care organization programs continue creating barriers to universal access for hepatitis C treatment. With the new policy to remove prior authorization for preferred direct acting antivirals, NYS Medicaid payors have an opportunity to ensure coverage parity across programs. 

“It is encouraging to see New York remove prior authorization requirements for first time hepatitis C treatment patients and help reduce further health complications and liver cancer,” said Robert Greenwald, Clinical Professor of Law at Harvard Law School and the director of CHLPI. “We encourage all payors and providers to immediately implement the new policies to help improve public health outcomes, especially during the coronavirus pandemic.”

For more information about NYS Medicaid hepatitis C treatment requirements, please visit https://stateofhepc.org/report/#NewYork.

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August 27, 2020

Harvard Center for Health Law and Policy Innovation Calls on Department of Justice to Enforce the Americans with Disabilities Act and Stop Health Insurers from Illegally Restricting Access to Critical Care

New research finds that hepatitis C treatment restrictions based on alcohol or drug use violate the Americans with Disabilities Act and undermine efforts to end the hepatitis C epidemic.

The Center for Health Law and Policy Innovation (CHLPI) of Harvard Law School is urging the U.S. Department of Justice (DOJ) to enforce the Americans with Disabilities Act (ADA) against discriminatory barriers to hepatitis C virus (HCV) treatment in both Medicaid programs and correctional health facilities. New research by CHLPI published in the July/August edition of Public Health Reports concludes that HCV treatment restrictions based on alcohol or drug use violate the ADA, which prohibits discrimination against persons with disabilities in public services, including people with substance use disorders who are seeking health care.

Although there is now a cure for HCV, cases have continued rising since 2010 due to the ongoing opioid use epidemic. Meanwhile 13 states deny treatment to Medicaid patients based on their alcohol or drug use, according to a recent snapshot of states with HCV treatment restrictions by CHLPI and the National Viral Hepatitis Roundtable (NVHR). Such restrictions are in conflict with the medical standard of care and ethical conduct of medicine. While court cases brought by Medicaid beneficiaries and incarcerated persons have been successful in removing other restrictions to care, such as those based on the severity of a patient’s disease, CHLPI concluded that the DOJ should enforce the ADA using its civil enforcement authority to remove sobriety restrictions for HCV treatment in Medicaid programs and correctional health facilities.

“Sobriety restrictions effectively feed this communicable disease, and they are especially damaging in the midst of the COVID-19 pandemic that places people with chronic conditions at greater risk, and in the middle of the opioid epidemic that is strongly linked to an increase in HCV prevalence,” said Robert Greenwald, a Clinical Professor of Law and the Faculty Director of the Center for Health Law and Policy Innovation at Harvard Law School. “Preventing care for patients with HCV who have a history of substance use disorder is illegal. We want to work with the DOJ to remove these harmful restrictions, but we are also committed to pursuing litigation if discrimination persists.”

DOJ enforcement of the ADA would be a faster and more effective avenue for eliminating sobriety-based restrictions than litigation brought by private parties. By expanding access to HCV treatment, this strategy could significantly reduce the spread of HCV infections, and improve public health.

“Sobriety restrictions perpetuate the stigma and discrimination associated with drug and alcohol use and limit efforts to prevent and treat hepatitis C among underserved populations,” said Michael Ninburg, Executive Director of the Hepatitis Education Project and NVHR. “We can eliminate hepatitis C in this country, but we need to ramp up testing and treatment in these same populations, including among people who inject drugs and prisoners.”

HCV infection rates in the United States tripled from 2010 to 2015 despite the introduction of new and effective treatment during this era. This increase is attributed in part to the ongoing opioid epidemic, as injection drug use is the most common method of new HCV transmission. With high initial prices for direct acting antiviral (DAA) drugs, several Medicaid programs and correctional health facilities created unfair systems to reduce their costs, including by limiting access to DAA therapies based on disease severity (as measured by liver damage), and based on periods of sobriety from drugs and/or alcohol before treatment.

Treating HCV reduces its prevalence, and treatment success with DAAs is extremely high regardless of alcohol use. With the public’s health at stake, especially during the COVID-19 pandemic, there is widespread disapproval of sobriety restrictions, including from the Centers for Medicare & Medicaid Services (CMS), the U.S. Department of Veteran Affairs, and other leading professional associations of Medicaid providers.

“HCV is curable and preventable, and no one deserves to be denied effective treatment. If we are going to stop the spread of HCV infection in the United States, it is critical that we expand access to DAA treatment to all who need it,” added Greenwald.

For More information: https://www.chlpi.org/harvard-center-for-health-law-and-policy-innovation-calls-on-department-of-justice-to-enforce-the-americans-with-disabilities-act-and-stop-health-insurers-from-illegally-restricting-access-to-critical/

August 1, 2020

Hepatitis C: The State of Medicaid Access

HCV_State-of-Medicaid-Access_August-2020-updateDownload

July 1, 2020

Iowa Lifts Barrier to Accessing Hepatitis C Treatment, but Some Discriminatory Restrictions Remain

Iowa Medicaid no longer requires severe liver damage for patients to access hepatitis C treatment, but strict sobriety and prescriber requirements continue to limit treatment availability.

July 1, 2020 – The National Viral Hepatitis Roundtable (NVHR) and the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) today applauded Iowa for removing the requirement that Medicaid patients have severe liver damage (fibrosis) before accessing hepatitis C treatment. While removing the fibrosis requirement has elevated Iowa from a “C” to a “B-“ rating, as a part of NVHR and CHLPI’s Hepatitis C: The State of Medicaid Access report, strict sobriety and prescriber requirements continue to limit the availability of treatment for Medicaid patients, which includes more than 686,000 Iowans.

“Removing the disease severity restriction is a great step forward for Iowans living with hepatitis C. Yet, Iowa must now also eliminate sobriety and prescriber restrictions in order to improve treatment access for rural Iowans and Iowans who use substances,” said Lauren Canary, Director of the National Viral Hepatitis Roundtable (NVHR). “With rising hepatitis C rates driven by unsafe injection drug use, we must remove all barriers to treatment and embrace harm reductions programs, including authorizing syringe services programs statewide.”

There are an estimated 12,600 individuals living with hepatitis C in Iowa who may be impacted by the current treatment restrictions. Iowa’s sobriety restrictions, which require three months of alcohol and substance use sobriety, are not evidence-based and run counter to established health and legal conceptions of treatment access for substance users. Similarly, Iowa Medicaid can further improve access to treatment by removing specialist prescriber limitations, which are not evidence based given the simplicity and safety of prescribing the treatment by primary care providers.  

“It is encouraging to see Iowa remove some restrictions on hepatitis C treatment access, but more must be done to minimize hepatitis C-related health complications and liver cancer,” said Robert Greenwald, Clinical Professor of Law at Harvard Law School and the director of CHLPI. “We celebrate Iowa for joining other states in reducing barriers to hepatitis C care and look forward to continued progress.”

Hepatitis C: State of Medicaid Access grades each state, as well as the District of Columbia and Puerto Rico, according to its overall “state of access.” Each grade is determined by curative treatment restrictions related to three areas: 1) liver disease progression (fibrosis) restrictions, 2) sobriety/substance use requirements, and 3) prescriber limitations – all of which contradict guidance from the Centers for Medicare & Medicaid Services (CMS), as well as recommendations from the American Association for the Study of Liver Diseases (AASLD) and the Infectious Disease Society of America. The report also offers suggestions for each state to reduce its treatment access requirements.

To read the full Iowa report card, visit https://stateofhepc.org/report/#iowa.

About the National Viral Hepatitis Roundtable (NVHR)

The National Viral Hepatitis Roundtable, a program of HEP, is a national coalition working together to eliminate viral hepatitis in the United States. NVHR’s vision is a healthier world without viral hepatitis. NVHR’s work is guided and informed by our beliefs and commitment to: Participation, Inclusiveness, Intersectionality, Health Equity, and Stigma Elimination. For more information, visit www.nvhr.org.

About the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI)

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 health care; to reduce health disparities; to develop community advocacy capacity; and to promote more equitable and effective health care 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. For more information, visit http://www.chlpi.org.

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May 21, 2020

Ohio Lifts Discriminatory Barriers to Accessing Hepatitis C Treatment

Increasing access to treatment will help Ohio increase hepatitis C treatment rates for more than 2.6 million Ohioans enrolled in Medicaid.

May 21, 2020 – The National Viral Hepatitis Roundtable (NVHR) and the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) today applauded Ohio removing discriminatory sobriety restrictions on access to treatment for hepatitis C. Ohio’s previous restrictions were limiting more than 2.6 million Ohioans enrolled in Medicaid from potentially accessing life-saving hepatitis C treatment if they needed it.

Ohio now has an “A-” rating as part of NVHR and CHLPI’s Hepatitis C: The State of Medicaid Access report.   The previous rating was a “C-”, for imposing strict sobriety restrictions that required six months of documented sobriety before authorizing treatment. These restrictions were not evidence-based and ran counter to established health and legal conceptions of treatment access for substance users. Ohio recently removed this barrier to treatment, and no longer asks about patient sobriety. Additionally, in early 2020 Ohio implemented a Unified Preferred Drug List that encompasses all Medicaid enrollees, eliminating previous access disparities and streamlining treatment authorization.

While this is great progress, Ohio retains one major barrier to treatment by requiring prescribing only by or in consultation with a specialist. Ohio could greatly expand access to hepatitis C treatment for the 89,600 estimated patients living with hepatitis C by removing this unnecessary limit on prescribing, given the simplicity of the treatment regimen and that it is associated with minimal to no side effects.

“Hepatitis C rates have been rising across Ohio for several years, as a result of the ongoing opioid use disorder epidemic that is strongly impacting Appalachian Ohio and other parts of the state. Yet requiring specialists to prescribe hepatitis C treatment limits access to care, especially at a time when many specialists are focused on the COVID-19 response,” said Lauren Canary, Director of the National Viral Hepatitis Roundtable (NVHR). “Increasing access to hepatitis C treatment will help curb the spread of this illness, which is critical at a time when liver disease puts more people at risk of complications from COVID-19.”

“Ohio’s discriminatory restrictions were harming thousands who are living with hepatitis C and creating ongoing health consequences despite the availability of a curative treatment,” said Robert Greenwald, Clinical Professor of Law at Harvard Law School and the director of CHLPI. “We commend Ohio for joining the many Medicaid programs across the country that have improved access to life-saving hepatitis C treatments.”

Hepatitis C: State of Medicaid Access grades each state, as well as the District of Columbia and Puerto Rico, according to its overall “state of access.” Each grade is determined by curative treatment restrictions related to three areas: 1) liver disease progression (fibrosis) restrictions, 2) sobriety/substance use requirements, and 3) prescriber limitations – all of which contradict guidance from the Centers for Medicare & Medicaid Services (CMS), as well as recommendations from the American Association for the Study of Liver Diseases (AASLD) and the Infectious Disease Society of America. The report also offers suggestions for each state to reduce its treatment access requirements.

To read the full Ohio report card, visit https://stateofhepc.org/report/#Ohio.

About the National Viral Hepatitis Roundtable (NVHR)

The National Viral Hepatitis Roundtable, a program of HEP, is a national coalition working together to eliminate viral hepatitis in the United States. NVHR’s vision is a healthier world without viral hepatitis. NVHR’s work is guided and informed by our beliefs and commitment to: Participation, Inclusiveness, Intersectionality, Health Equity, and Stigma Elimination. For more information, visit www.nvhr.org.

About the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI)

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 health care; to reduce health disparities; to develop community advocacy capacity; and to promote more equitable and effective health care 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. For more information, visit http://www.chlpi.org.