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Medicaid HCV Treatment Restrictions Denying Care & Treatment, which HCV Guidelines Committee Supported
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from Jules: as I say in these following reports distributed to you over the past 4-7 weeks, some state medicaid programs have constructed what many consider illegal restrictions to HCV treatment, even Matt Salo, a director of a national medicaid organization said lawsuits are likely to be upheld in court & lawsuits appear to be pending. These medicaid restrictions say: we will only treat patients with advanced HCV disease (F3/F4), despite that we all know full well that once a patient has advanced disease liver cancer risk persists despite achieving a cure, the only way to prevent this risk is to treat early; the 2nd restriction is they will not treat drug users, California requires a urinalysis, despite that injection drug use is the leading cause of HCV transmission, how absurd & incredible this restriction is & how harsh & punitive; the 3rd restriction is only hepatitis experts can treat the disease, meaning HIV/ID doctors who have been treating HCV coinfection for years & are often excellent can not treat HIV connected patients or HCV; hepatitis experts are not expert in treating HIV+ individuals, in fact many of them prefer not to treat HIV+ individuals, another incredibly absurd restriction. Earlier this year medicaid's & commercial payers launched a misleading deceptive PR campaign whose goal was to convince the public the new life-saving HCV "cure" drugs would bust their budgets & were too expensive. They said it cost them $84,000 for Sovaldi, 1st deception, medicaid gets a minimum 24% discount/rebate which is negotiable, that reduces price to perhaps $63,000 or less, the VA gets a 44% discount/rebate, commercial payers behind the scenes negotiate for discounts and receive them. The Social Security Medicaid Rebate Law says in return for a 23% rebate state medicaid is to provide treatment, there is no mention of permissible restrictions.....
http://www.natap.org/2014/HCV/081914_01.htm
......http://www.ssa.gov/OP_Home/ssact/title19/1927.htm. Commercial payers are required to provide access to treatment. In fact United HealthCare says HCV treatment is cost effective http://www.natap.org/2014/HCV/062514_07.htm. Second mischaracterization: the costs they claimed were hyper inflated, they were projections, they discussed the millions of patients who would be treated & their projected costs were based on those projections. Only 70,000 this year have been treated with Sovaldi nationwide, when telaprevir & boceprevir were approved only 100,000 were treated in the first year, our healthcare system is such that patients are not all treated at once, it takes time to process through the system. HCV treatment is a cure with 12 weeks therapy so all the cost is upfront but after a patient is cured its over, no more expenses essentially: a one time cost of $45-65,000 for medicaid & the VA. Every year in perpetuity the federal govt spends $22 bill on HIV care & treatment in the USA, $4.5 bill for medicare & $5 bill for medicaid, why don't payers complain about this, they pay for this, its politics, they would be crucified if they attempted to not pay for this. But in HCV they are trying to get away with it, to set a precedent I believe for coming expensive innovative cancer treatments, which will not cure a disease but offer extended life. Let's see if the medicaid & commercial payers refuse to pay for this, diseases that occur to 'normal' people, not 'drug users' who have HCV. Our healthcare system is broken, we know that, but we need a system that works for an HCV cure & other life-saving innovative treatments; Healthcare should not be based on the one-year budget system, in the USA we have an odd system where any patties are involved in paying which muddies the water, we need a new system that provides access to care & treatment: http://natap.org/2014/HCV/080614_02.htm. Yesterday Businessweek http://www.businessweek.com/articles/2014-08-18/sovaldi-why-the-u-dot-k-dot-will-pay-for-the-84-000-hepatitis-c-drug discussed that Britain is paying for Sovaldi and said: The U.K.'s decision to recommend Sovaldi was far from a sure thing. But once the National Institute for Health and Care Excellence was convinced that Sovaldi is cost-effective, the decision to pay for it is simple, because one entity pays for all the medical care in the U.K. If treating a patient with costly drugs now prevents a more expensive liver transplant in 15 years, that savings accrues to the National Health Service-and ultimately to British taxpayers. That's not the case in the U.S., where health care is paid for by a mix of employers, private insurers, and government programs such as Medicaid and Medicare. Hepatitis C can take 20 to 30 years to cause liver scarring that might require a transplant. An insurer paying for Sovaldi now is probably preventing an expensive treatment that would have ultimately been paid for by another part of the health-care system-most likely Medicare, the federal insurance program for Americans 65 and older. Insurers don't have much incentive to do that, even if it would save the U.S. health system money in the long run.
Medicaid HCV Treatment Restrictions Denying Care & Treatment, which HCV Guidelines Committee Supported
HCV/Medicaid Law Suits Coming - (08/22/14)
HCV Treatment, HIV Treatment: public & personal health denied - HCV Cost Burden - commentary - (08/11/14)
Medicaids/ Feds Deny HCV Treatment to Poor/Disenfranchised, Those Most Affected by HCV- - (08/19/14)
Medicaid Restrictions, Opoid Replacement Therapy, African-Americans, Depression/Comorbidities....is this legal? A lawsuit- "swift overturn in courts" - (08/18/14)
Medicaids Restrictions Based on Misleading Information: African-Americans/ Opoid Replacement (Methadone) Users SVR Rates, comorbidities - (08/18/14)
HCV Guidelines Questionably Prioritize The Sickest To Be Treated, New Guidelines Section- "WHEN AND IN WHOM TO INITIATE HCV THERAPY" - commentary - (08/12/14)
Illinois restrictive criteria: ATTACHED IS THE PDF- Sovaldi (Sofosbuvir)-HFS Criteria for Prior Approval Final: July 10, 2014. Download the PDF here
Interview with Illinois Medicaid Medical Director Re: their new restrictions on Sovaldi Access - (08/08/14)
New Models for Healthcare Funding Needed - (08/06/14)
New California HCV Treatment Restrictions.....requires urine-analysis/denies access to drug users unless abstinent for 6 months/requires advanced disease to be treated - (08/28/14)
Treating HCV Earlier vs at Cirrhosis Reduces Serious Liver Disease Outcomes - (08/08/14)
HCV Could be a "Rare Disease" by 2026, "1-time HCV screening for all/test & treat"..... need for more aggressive screening strategies and higher treatment capacity.....1-time universal screening - new study projects - (08/06/14)
Earlier HCV Treatment Reduces Serious Liver Disease Outcomes - (08/12/14)
DDW: VA Patients Are Good Candidates for Early HCV Treatment - (08/13/14)
Emerging Epidemic of Hepatitis C Virus Infections Among Young Non-Urban Persons who Inject Drugs in the United States, 2006-2012 - (08/20/14)
Oregon Sovaldi Decision Tabled - (08/18/14)
Oregon Medicaid Restricts HCV Therapy Access....A Symptom of a Failing Healthcare System That Denies Human Dignity & Life - (08/05/14)
UK NICE Sovaldi Guidance - "We are pleased to be able to provisionally recommend sofosbuvir as a clinically and cost effective treatment for some people with chronic hepatitis C" - (08/18/14)
Australia's PBAC, Pharmacy Benefits Program, akin to Medicaid in USA, Rejects Sofosbuvir, here is their language - (08/25/14)
Iowa Prisons Use Sovaldi - (09/10/14)
HIV Medical Associations Challenge Insurer Restrictions to HCV Treatment - IDSA/ HIVMA/AAHIVM - (09/03/14)
Florida Medicaid HCV Criteria for Olysio (simeprevir) - (08/30/14)
Florida-Medicaid HCV Criteria/Sovaldi .....August 8, 2014 pdf attached - (08/30/14)
Florida Medicaid Adds $1,000-a-Pill Drug - (08/30/14)
FLorida Medicaid Limits Hep C Drug - (08/30/14)
Medicare Premiums/ HCV - New Millman Report - (08/01/14)
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