Medicaid managers seek ways to pay for costly specialty drugs

Medicaid managed-care plan operators are looking for a way to pay for high-priced specialty drugs such as Sovaldi and Harvoni, the $1,000-per-pill treatments approved by the Food and Drug Administration to treat hepatitis C.

The Medicaid Health Plans of America also will be looking to put a human face on their operations when they hold their annual conference in Washington this week. With more states moving Medicaid beneficiaries into managed-care organizations, and Medicaid rolls in over half the states growing thanks to the Patient Protection and Affordable Act, the national trade group plans to highlight personal anecdotes from customers. One plan has prepared an emotional story about how it provided high-quality care for 9-year-old Julia Lindenmuth, who has a debilitating disease.

Enrollment of Medicaid and Children's Health Insurance Program beneficiaries in managed care will increase by 13.5 million by 2016, according to consulting firm Avalere Health. That will bring total managed-care enrollment to 76% of all Medicaid and CHIP enrollees, up from 67% in 2013.

But the bottom-line issue on the conference agenda focuses on the budgetary pressures facing state governments because of high-priced hepatitis C drugs. Attendees can learn best practices in pre-treatment assessment, the importance of monitoring alcohol and weight, psycho-social elements, post-treatment strategies and how to communicate the dangers of not following a post-treatment protocol.

The concern: Once the $100,000 regimens are approved, patients need to stick with them. Some states have implemented a “once in a lifetime” rule for Sovaldi. Similar policies are expected for newly released Harvoni.

The conference also will feature sessions on patient engagement. The aim is to teach plan managers how to structure member engagement and incentive programs so they produce the desired behavioral changes and a return on the investment.

Follow Virgil Dickson on Twitter: @MHVDickson