Feds: Medicaid programs restricting pricey hep C med access may be violating law
- Federal officials from the Department of Health and Human Services on Thursday sent state Medicaid directors a notice warning them against blocking patients' access to pricey hepatitis C drugs, the Wall Street Journal reports.
- In an effort to counteract the high prices of next-gen hep C therapies such as Gilead's Sovaldi/Harvoni and AbbVie's Viekira Pak, some state Medicaid programs have ramped up the requirements for patients to receive the medicines. For instance, some programs have only been covering the drugs for hep C patients with severe liver disease, or those who can prove abstention from drugs and alcohol. Such actions may violate federal statutes requiring Medicaid programs to cover medically necessary treatments that have been cleared by the FDA.
- But pharma companies didn't come away unscathed in the CMS notice, either. In a blog post, CMS acting administrator Andy Slavitt also called out companies for the high price of hep C drugs, arguing that "it can appear as if some of those who produce the pharmaceuticals and those whose lives often depend on them have unaligned interests."
The pricing wars on hep C medications continue to pit payers, pharma companies, and regulators against each other.
While Slavitt contended that Medicaid programs can't arbitrarily break off medication access to beneficiaries without possibly running afoul of federal law, he also admitted that the reason Medicaid programs feel the need to act this way is the exorbitant cost of these medications, which can run as high as $90,000 for a 12-week treatment course before discounts.
Slavitt urged drug makers to make "value-based" pricing arrangements with state payers in order to reduce budgetary burdens.
Pharmaceutical companies have consistently argued that the high price of these medicines are necessary in order to recoup R&D costs, and given that the drugs have hugely successful cure rates that eliminate the need for even bigger downstream costs such as liver transplants.