Dive Brief:
- Government programs and private insurers alike are expanding their coverage of high-cost hepatitis C drugs in response to legal and lobbying efforts demanding broader access, Kaiser Health News reported.
- Insurers had previously restricted coverage to patients with advanced liver disease due to the average sticker price of $54,600 to $94,500 for 12-week course of treatment.
- Numerous states and private insurers are responding to the legal pressure and quietly reversing their policies, including Anthem, United HealthCare and seven insurers serving New York due to a March legal settlement.
Dive Insight:
Insurers will be hard pressed to hold out on coverage any longer given the acceptance that the current crop of drugs are real cures, not just treatments with marginal benefits, and that cost alone is not an acceptable argument against treatment.
“I think the writing is on the wall for restrictive policies, and plaintiffs are likely to prevail in these lawsuits,” Nicholas Bagley, a professor of law at the University of Michigan, told Kaiser Health News.
The issue for state programs and private insurers is how to offset the expense, though advocates point out that early treatment will also reduce longterm costs associated with increased transmission and complications including liver failure, cancer, and kidney disease. In addition, prices are projected to come down as competition increases, and states are said to be bargaining to get price concessions.
Massachusetts has turned around its policy after a lawsuit induced drug companies to provide the state with bigger rebates, and restrictions have also recently been lifted in Florida, New York, Delaware, and Washington.