- Seven New York health insurers on Tuesday agreed to broaden coverage of new, costly hepatitis C drugs after reaching a deal with the New York Attorney General's office. The agreement requires the insurers to cover treatment regardless of disease severity or whether patients use alcohol or drugs.
- Previously, five of the seven insurers had limited access to the new hepatitis drugs only to those patients with advanced stages of the disease. Four denied coverage if members used alcohol or drugs.
- The new antiviral medications, such as Gilead's Harvoni or Merck's Zepatier, are highly effective but can be costly. List prices for the drugs (before rebates or discounts) range from $54,600 to $94,500, prompting some insurers to limit coverage in an attempt to reduce costs.
Under the terms of the deal, the insurers will now eliminate restrictions requiring patients have advanced hepatitis C to qualify for treatment. Additionally, coverage cannot be denied based on alcohol or drug use by members, and other providers besides specialists will now be able to authorize treatment.
The seven health insurers included in the agreement with the State Attorney General's office are Affinity Health Plan, Empire BlueCross BlueShield, Excellus Health Plan, HealthNow, Independent Health, United Healthcare/Oxford, and MVP Health Plan.
“New Yorkers diagnosed with Hepatitis C deserve to be treated, and these agreements will vastly improve access to the medications needed to cure their disease,” said Attorney General Schneiderman. “My office will do everything possible to ensure treatment for Hepatitis C is available, so that patients can be cured and we can minimize the spread of the disease to others.”
The changes must be implemented within 45 days, according to the Attorney General's office.
Health plans remain wary of the cost wider coverage will entail. "The fact remains, however, that newer drugs being used to treat Hepatitis C are exorbitantly expensive," said New York Health Plan Association President Paul Macielak in a statement on the agreement.
"HPA believes New York should focus on affordability by taking a more aggressive position on the excessive pricing of these Hepatitis C drugs," he said.
Competition between drugmakers could slowly start to shift the cost curve downward. When Merck launched its hepatitis C treatment Zepatier, it priced the drug at nearly half the cost of Gilead's Harvoni. Given the stranglehold Gilead's treatments have on the market, however, it would likely take some time for cheaper alternatives to have a widespread effect.