R.I. expands coverage of hepatitis C-fighting drugs to all Medicaid enrollees

PROVIDENCE — When Medicaid enrollee Michelle Giron was denied coverage for hepatitis C-curing drugs the second time in May, she and the Rhode Island Center for Justice challenged state policy limiting approval to people with severe liver damage, effecting a reversal that will aid all Rhode Island Medicaid members with the disease.

Giron, of Providence, diagnosed with the viral infection several years ago, was denied coverage for Direct Acting Anti-Viral Drugs to treat hepatitis C, first by Blue Cross Blue Shield of Rhode Island, then by Neighborhood Health Plan of Rhode Island, said Jennifer Wood, Executive Director of the Rhode Island Center for Justice. The FDA began approving the drugs in 2011, and in 2014 approved drugs in that family that can effectively cure the disease.

In 2015, the federal Centers for Medicare and Medicaid Services instructed states they needed to review their polices regarding coverage of the drugs, but Rhode Island’s policy remained unchanged until 2018, when Giron approached the RICJ, Wood said.

The RIJC notified the Executive Office of Health and Human Services in May that they intended to challenge the policy on Giron’s behalf, but the challenge never made it to court, Wood said.

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“I’m very happy to say that once we did contact EOHHS, we were able to work out a solution very quickly,” Wood said.

The EOHHS agreed to change its policy, approving coverage for any Medicaid beneficiary living with hepatitis C.

“The weight of the world has been lifted off my shoulders. Now, I’m excited about my future. I think that everyone else who’s in my position feels the same way. It’s like getting a new lease on life,” Giron said.

About 2 percent of Rhode Islanders, an estimated 16,603 to 22,660 people, have been infected with HCV. Roughly 20 percent of those infected with hepatitis C will fight off the infection, according to the RIDOH 2016 Rhode Island HIV, Sexually Transmitted Diseases, and Viral hepatitus Surveillance Report. The remaining 80 percent are at risk of developing chronic disease.

Chronic hepatitis C can cause long-term health problems, including liver damage, liver failure, liver cancer, or even death, according to the CDC. It is a major cause of cirrhosis and liver cancer and the most common reason for liver transplantation in the United States.

Hepatitis C-related deaths in Rhode Island rose from 25 in 2005 to 102 in 2014, based on data from death certificates, which may under-report hepatitis C-related deaths, according to the state report.

“Rhode Island has taken an important step here,” said Kevin Costello, director of litigation at the Center for Health Law and Policy Innovation of Harvard Law School. “This change is not only the right thing to do from a public health and legal point of view, but it also been proven that this policy will be cost-effective for the state in the long run. And it goes without saying that the real potential of this cure is the eradication of HCV altogether, a goal that is furthered by early treatment of Medicaid beneficiaries that makes, in their case, further transmission of the virus impossible.”

“A comprehensive, public health approach of prevention and screening, that now includes treatment for all, is key to our goal of eliminating HCV [hepatitis C] in Rhode Island,” said Director of Health Dr. Nicole Alexander-Scott. “Public health, State institutions, clinical organizations, and community agencies need to all work together to address this epidemic and ensure that access to prevention and treatment does not depend on one’s ZIP code, insurance status, or any other factors.”

RIDOH’s efforts to curb the spread of the disease include preventing hepatitis C transmission through the ENCORE needle exchange program, administered by AIDS Care Ocean State, which provides services to about 500 clients. RIDOH also funds community-based agencies to conduct rapid hepatitis C testing and link people to care. RIDOH has recently established a relationship with the Rhode Island Health Center Association to facilitate improvements in hepatitis C screening, diagnosis, and treatment in Federally Qualified Health Centers that serve low-income patients, according to the EOHHS.

Rob Borkowski is a PBN staff writer. Email him at Borkowski@PBN.com.