Colorado recently expanded access to Hepatitis C treatment for Medicaid patients, but that policy change is a “half-step” that still leaves too many people unable to get newer and more effective drugs for the viral disease, the ACLU said in a class action lawsuit filed Monday.
Hepatitis C is a blood-borne infectious disease that attacks the liver and can lead to liver failure, cancer and even death. An estimated 14,400 Coloradans on Medicaid currently have hepatitis C.
Until recently, Colorado wouldn’t pay for newer drugs for Medicaid patients unless the person had a fibrosis score — a measure of liver scarring — of F3 or F4. The drugs are effective in 90 percent of cases or more, according to ACLU.
Under pressure from the American Civil Liberties Union, the Colorado Department of Health Care Policy and Financing, which administers Medicaid here, announced that people with a score of F2 and women who wish to become pregnant could have the newer, more expensive drugs.
But that’s not enough, the ACLU said.
“The latest policy change is a half-step that falls short of what the law requires, which is full access to medically necessary treatment for all patients with Hepatitis C,” ACLU of Colorado staff attorney Sara Neel said in a press release.
“The ill-conceived pregnancy exception perversely incentivizes women to either commit to get pregnant or to lie to their doctor about their family planning decisions in order to gain access to treatment.”
The lawsuit names one plaintiff, Robert Cunningham, on behalf of a larger class of plaintiffs. Cunningham is a Medicaid patient with Hepatitis C and a fibrosis score of F1. He was denied access to the new treatments because he isn’t considered sick enough.
“Mr. Cunningham is ‘frustrated, irritated, disheartened, and disappointed,’ because other insurances offer the treatment that he needs,” the lawsuit says.
“He is very stressed that the disease could kill him, that he could pass it on to others, and that it will continue to limit him physically. He has agreed to participate in this litigation not only to secure treatment for himself, but to help others in his position secure treatment as well.”
A spokesman for the Department of Health Care Policy and Financing said in an email that the department is aware of the lawsuit but has no comment at this time.