St. Louis University Legal Clinics has dropped its lawsuit against the state after it agreed to offer full coverage for drugs that cure Hepatitis C. Missouri had declined to cover most Medicaid patients for drugs such as Harvoni and Sovaldi, that have been on the market for several years.
Photo courtesy of the Centers for Medicare and Medicaid Services
The state actually announced its change in policy November 1st, but according to St. Louis University Law Professor John Ammann, the plaintiffs wanted to make sure their clients were being treated.
“We wanted to make sure that our clients started getting the medication so that the policy was in place before we missed the suit,” said Amman. “And our clients, who are the three main plaintiffs in the case, have started on the drugs. So, we felt comfortable dismissing the lawsuit yesterday.”
Legal Services of Eastern Missouri and the National Health Law Program joined St. Louis University in the lawsuit.
Major health insurers, as well as Medicare and the Veterans Administration have been covering the drugs for anyone with hepatitis C. The state Department of Social Services (DSS) had balked at covering Medicaid patients because of heavy cost, an argument Ammann finds unconvincing, given the federal program’s matching funds.
“Really almost two-thirds of the cost of Medicaid for these drugs would’ve been paid for by the federal government. So, the costs to general revenue in Missouri would’ve been totally doable in our view.”
Ammann further points out that a state agency had denied treatment in the rare case where there’s a drug available that actually cure’s a virus that can be debilitating.
“It was the Department of Social Services who had this very restrictive policy that allowed people to suffer needlessly,” Amman said. “These drugs were available to cure them, and the state would not cover them.”
He thinks the pressure of the lawsuit, as well as incentives in the form of rebates from the drug manufacturers, persuaded DSS to change its policy.
Abigail Coursolle, an attorney with the National Health Law Program notes Missouri is not alone in resisting Hepatitis C coverage.
“Missouri, like too many states, has failed to follow federal and state guidelines on providing their Medicaid beneficiaries with prompt access to Hep C treatment that we know cures this disease,” said Coursolle. “We are glad that Missouri health officials will start to ensure that Medicaid enrollees receive these medications in a timely manner,”
Dr. Bruce Bacon, co-director of the Saint Louis University Liver Center echoed Ammann’s point that the Hepatitis C treatments now available have an unusually high rate of success.
“A medication which can totally cure a disease is a rare occurrence,” said Bacon. “We have hundreds of patients who have been waiting to get this medication for years, and now they will be cured.”
The lawsuit, which was formally dropped Monday was filed in October of 2016. It challenged the Missouri Medicaid policy that only provided new breakthrough drugs which cure hepatitis C to the sickest people with the disease, those with the most damage to their liver.
