A federal judge has ordered Washington Medicaid to provide an expensive drug to all hepatitis C patients, not just the sickest ones.
U.S. District Judge John C. Coughenour granted a preliminary injunction Friday that forces the state Health Care Authority to stop a 2015 policy that restricted access to the drugs based on a measure of liver scarring, the Seattle Times reported.
The injunction was a response to a class-action lawsuit filed in February on behalf of two clients of Apple Health, which is Washington's version of Medicaid. The two patients, who represent nearly 28,000 Medicaid enrollees with hepatitis C, were denied the drug Harvoni to treat their hepatitis C infections. It costs about $95,000 for a 12-week treatment.
Harvoni is among the newest drugs that can halt the hepatitis C virus, posting a cure rate of at least 90%.
The judge ruled that the agency's policy was not consistent with existing state and federal Medicaid requirements that drugs be dispensed based on medical need.
"For people who have been living with this disease and feeling like there's no hope if they can't get this cure, this is life-changing," said Eleanor Hamburger, a lawyer with the firm Sirianni, Youtz, Spoonemore and Hamburger, which filed the lawsuit.
It's not clear how soon Medicaid patients with hepatitis C may begin filling prescriptions for Harvoni and other direct-acting antiviral drugs. The ruling orders all parties to report back within 60 days.
Health Care Authority officials are reviewing the injunction, a spokeswoman said. But the state Medicaid director, MaryAnne Lindeblad, estimated in a letter to the U.S. Senate last fall that paying for hepatitis C treatment for all Medicaid clients in Washington would be three times the agency's current drug budget.
Medical guidelines had previously supported limiting the drugs to the sickest patients, but that changed last year. Experts in liver treatment and infectious disease now agree that drugs such as Harvoni should be used to treat all patients, including those with mild disease.
Two similar class-action suits in Washington state targeted private insurers Group Health Cooperative and BridgeSpan, a subsidiary of Regence Blue Shield, for rationing the drugs. BridgeSpan changed its policy to provide the drugs to all hepatitis C patients, and Group Health altered its plan to allow consideration of treatment for people with lower levels of liver scarring.