A new class-action lawsuit aims to compel Texas to provide Medicaid beneficiaries with hepatitis C medications no matter the cost.
The state limits treatments only to beneficiaries who already are experiencing severe liver damage, even though others with the infection can develop the same health problems.
The lawsuit was brought on behalf of three Texas plaintiffs who have the infection against officials with the Texas Health and Human Services Commission, which administers Medicaid in the state. It was filed in the U.S. District Court, Western District Of Texas, Austin Division.
The antiviral medications, which the Food and Drug Administration first began approving in 2011, represent a vast improvement over earlier treatments. They are far more effective, with 95% or better cure rates, can be taken for shorter periods of time and produce no side effects.
But they are far more expensive, initially costing $84,000 or more for a 12-week course of treatment. Competition has brought prices down somewhat since then, but treatments remain expensive.
The price rattled insurers of all types because of the prevalence of hepatitis C. According to the Centers for Disease Control and Prevention, more than 3 million Americans have the virus.
States tried to ration treatments for both their Medicaid and prison populations, the latter of which are particularly affected by hepatitis C. Many states, including Texas, limit treatments to patients whose symptoms were the worst.
Advocates contend, however, that without treatment, many of those with less severe or no symptoms could progress to serious conditions, including liver cancer or liver failure, and it is unfair to deny them medication to save money.
Both the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America said the antiviral drugs should be available for all patients with chronic hepatitis C infection, except those with a short life expectancy that the treatment wouldn’t help.
Courts in a number of states around the country, including Indiana, Michigan, Missouri and Washington, have affirmed the rights of either Medicaid beneficiaries or prison inmates to have access to the hepatitis C drugs.