The Health Care Authority on Monday reached a settlement agreement in a class action lawsuit that sought broader coverage of costly hepatitis C drugs for Medicaid patients in Washington state.
The settlement has yet to be approved by a judge but lawyers are hopeful it will be soon.
In the past several years, multiple pharmaceutical companies nationwide have developed direct-acting antiviral drugs that cure hepatitis C in more than 90 percent of patients. But the drugs are extremely expensive – for example, Harvoni, introduced in 2014, has a list price of $1,100 a day, or $94,500 for a 12-week course. (After automatic drug rebates and other discounts, Medicaid pays about half that price for each patient.)
But under the state’s previous restrictions, Medicaid patients with hepatitis C could only access the expensive curative drugs if they had advanced liver disease, gauged by a “fibrosis” score, which measures the level of scarring on the liver.
A class suit representing about 28,000 Medicaid patients was filed against the Health Care Authority in February, alleging that 900 people in the state had been denied access to curative treatment based on their fibrosis score. A preliminary injunction was issued in May, barring the state from denying coverage based on fibrosis score. If approved, the settlement agreement would make that change permanent, opening access to medically necessary treatment to all hep C patients covered by Medicaid.
“The state agreed to remove the fibrosis scores as … a means of rationing who got access to the drugs,” said attorney Amy Crewdson with Columbia Legal Services, which filed the lawsuit along with Seattle law firm Sirianni Youtz Spoonemore Hamburger. For sick patients seeking a cure, “Fibrosis scores were the big barrier.”