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NY AG: "Will do everything to ensure treatment availability so patients can be cured", Lisa Landau's Office did investigation
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Lisa Landau's Office Health Care Bureau conducted investigation.....A.G. Schneiderman Announces Major Agreement With Seven Insurers To Expand Coverage Of Chronic Hepatitis C Treatment For Nearly All Commercial Health Insurance Plans Across New York State
Insurers In New York Will No Longer Restrict Treatment For Hepatitis C Based On Disease Severity
As AG agrees on Hepatitis C treatment with insurers, CDPHP still faces lawsuit
"Hepatitis C is a potentially life-threatening disease and thousands of New Yorkers are diagnosed each year," Schneiderman said in a statement. "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."
"These insurers have now agreed to not deny coverage based on members' alcohol or drug use and to permit appropriately trained providers to authorize treatment......By removing these three restrictive criteria, the insurers' Hepatitis C coverage policies will more closely reflect evidence-based guidelines for treatment of chronic Hepatitis C infection.
The seven health plans must fully implement the revised criteria within 45 days of the agreement and will send notices to members who were denied coverage who may now be eligible for treatment. The investigation of this matter was conducted by Assistant Attorneys General Elizabeth Chesler and Adrienne Lawston, with assistance from Volunteer Attorneys General Matthew Reisman and Samuel Canales, of the Health Care Bureau, which is led by Bureau Chief Lisa Landau.
As a result of these agreements, nearly all commercial health insurance plans in New York State will cover treatment for chronic Hepatitis C without requiring members to develop advanced disease, such as liver scarring, and will not deny coverage because the member uses alcohol or drugs, or because the authorizing physician is not a specialist.".......http://www.ag.ny.gov/press-release/ag-schneiderman-announces-major-agreement-seven-insurers-expand-coverage-chronic
Apr 26, 2016, 12:33pm EDT
http://www.bizjournals.com/albany/news/2016/04/26/as-ag-agrees-on-hepatitis-c-treatment-with.html
"The plans will have to change treatment guidelines within 45 days and send notices to members who were denied coverage and might now be eligible.
"CDPHP expressed a willingness to join that agreement; however, the AG refused to allow our participation."
States have also put restrictions on access to the drugs to control costs and negotiated rebates from manufacturers. New York's Medicaid fee-for-service program has similar requirements for patients to access Harvoni and Sovaldi, although those were eased for Viekira Pak in April 2015.
"A state panel is set to review the guidelines in the Medicaid program for coverage of Hepatitis C drugs Wednesday."
The seven insurers included in the agreement are MVP Health Plan, Empire BlueCross BlueShield, HealthNow of New York Inc., Affinity Health Plan, Excellus BlueCross BlueShield, Independent Health and United Healthcare/Oxford."
Insurance plans must remove restrictions on access to expensive Hepatitis C treatments under an agreement with New York state's attorney general.
Seven insurers, including MVP Health Care, Empire BlueCross BlueShield and the parent of BlueShield of Northeastern New York, will change their policies, according to a statement from Attorney General Eric Schneiderman's office.
"Hepatitis C is a potentially life-threatening disease and thousands of New Yorkers are diagnosed each year," Schneiderman said in a statement. "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 agreement comes after Schneiderman filed a lawsuit against Albany nonprofit insurer CDPHP over its coverage of Hepatitis C drugs. His office also subpoenaed information on the issue from all insurers in the state.
CDPHP's chief strategy officer said in a statement the insurer was willing to join the agreement but the attorney general refused to allow it to participate. The attorney general's office did not immediately respond to a request for comment.
New blockbuster drugs that have been successful in treating Hepatitis C, a potentially fatal infection that can lead to liver scarring or failure, can cost more than $83,000. The cost of the treatments, including Gilead Sciences Inc.'s Harvoni and Sovaldi and more recently AbbVie Inc.'s Viekira Pak, has alarmed government insurance programs and private insurers.
The agreement with the attorney general represents a new consensus approach to developing drug coverage policies, New York Health Plan Association president and CEO Paul Macielak said in a statement. He also noted the high cost of these drugs, which drives up costs for individuals and businesses.
"New York should focus on affordability by taking a more aggressive position on the excessive pricing of these Hepatitis C drugs," he said.
The seven insurers included in the agreement are MVP Health Plan, Empire BlueCross BlueShield, HealthNow of New York Inc., Affinity Health Plan, Excellus BlueCross BlueShield, Independent Health and United Healthcare/Oxford.
For patients to get treatment, the insurers will not require members to develop liver scarring or other advanced symptoms, deny coverage because of drug or alcohol use, or require a specialist to prescribe it, according to the attorney general's office.
Previously, some insurers had some of those policies in place, but only one insurer had all three, according to the attorney general's office.
The plans will have to change treatment guidelines within 45 days and send notices to members who were denied coverage and might now be eligible.
States have also put restrictions on access to the drugs to control costs and negotiated rebates from manufacturers. New York's Medicaid fee-for-service program has similar requirements for patients to access Harvoni and Sovaldi, although those were eased for Viekira Pak in April 2015.
A state panel is set to review the guidelines in the Medicaid program for coverage of Hepatitis C drugs Wednesday.
CDPHP was willing to work on its policy with the attorney general and other regulators prior to being sued by the state, senior vice president for strategy and communications and chief strategy officer Bob Hinckley said in a statement.
Hinckley said CDPHP told Schneiderman the issue of Hepatitis C drug coverage and his office's concerns would be discussed at an April 13 pharmacy committee meeting. Schneiderman announced his lawsuit April 14.
"The AG chose to commence legal action instead. Simultaneously, the AG opened discussions with other health plans to negotiate their proposed policy changes," he said. "CDPHP expressed a willingness to join that agreement; however, the AG refused to allow our participation."
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