State Expands Access to Hepatitis-C Drugs for Medicaid Patients

Proposed rule change would allow patients to receive treatment before they exhibit some degree of liver damage

Hepatitis C virus
Medicaid patients suffering from hepatitis C could soon get coverage for potentially life-saving medications — before they suffer serious liver damage — thanks to a policy change and new funding the Murphy administration said brings New Jersey’s program in line with those in neighboring states.

New Jersey officials have proposed a rule change that would enable those individuals to access drugs that can potentially cure them of hep-C, a viral liver infection earlier in the course of their disease; currently, these drugs are only covered after a certain level of liver damage is detected in the patient. A growing number of states have abandoned similar requirements in recent years as the price of these costly treatments has started to decline.

In addition, Gov. Phil Murphy, a Democrat who took office in January, allocated more than $10 million — nearly $8 million from federal sources — to expand Medicaid hep-C services in his budget proposal for fiscal year 2019, which starts in July. According to one study, Medicaid patients are more than seven times more likely to have hepatitis than the noninstitutionalized public at large.

Money for Medicaid

Overall, Murphy’s $37.5 billion spending plan includes $4.3 billion in state funding to expand coverage for vulnerable residents, according to the Department of Human Services, which oversees Medicaid and other social service efforts. The program covers nearly 1.8 million New Jerseyeans and costs nearly $15 billion annually, two-thirds paid by the federal government.

“Building a stronger and fairer New Jersey for all residents includes ensuring that we are continually improving our Medicaid program to give New Jersey families access to the services they need,” said acting DHS commissioner Carole Johnson, who highlighted the hep-C change at a policy conference in late March. “The governor’s budget delivers on that commitment” in multiple ways, she said.

The move was praised by former Gov. Jim McGreevey, a Democrat who now runs the New Jersey Reentry Corp. and has championed prisoners’ rights. McGreevey, who also attended the policy conference, said the change would have a significant impact on the health and welfare of the former inmates he works with daily.

“This is so critically important,” McGreevey said, calling the state’s previous policy regarding hep-c coverage “intractable and Byzantine, at worst.”

Murphy’s budget also cut millions from other healthcare-related programs – including $4 million for McGreevey’s reentry initiative — efforts that his staff framed as healthcare priorities for former Gov. Chris Christie, a Republican.)

Nationwide, an estimated 2.7 million to 3.9 million Americans have chronic hep-C, an inflammation that can lead to liver failure and even death. This includes an estimated 8,000 Garden State residents who have been diagnosed with the disease and another 150,000 who are carrying the virus without their knowledge.

How hep-C is spread

The disease is spread through contact with infected blood or other body fluids and it is nearly five times more common in baby boomers, or Americans born between 1945 and 1965 — an era when less was known about safe sex, safe injection practice, and blood testing.

(Blood samples were not routinely screened for hep-C in New Jersey until the early 1990s — several years after state Sen. Joseph Vitale’s father received a blood transfusion that was infected and eventually led to his death. Vitale (D-Middlesex), the chair of the Senate health committee, recalled this story at the conference and noted he has proposed legislation that would require baby boomers be offered a blood screening for the disease.)

According to an academic study published in December by the Infectious Disease Society of America, Medicaid programs across the nation have been re-assessing how they cover hep-C treatments in recent years. On average, these Medicaid patients are 7.5 times more likely to have the disease than the public at large, researchers found, and their care costs Medicaid roughly four times what the program pays for individuals without the disease.

The study found that in 2014, 28 states — including New Jersey — required patients to have some level of fibrosis, or liver damage, often measured by radiologists using a “Metavir score,” before Medicaid would pay for their drugs. Another 32 states required patients to prove they were not abusing illegal substances in order to qualify. By 2016 this had changed to 18 and 27 states, respectively, the researchers found.

Hep-C treatments were once extremely limited, but this began to change in 2011, when federal officials approved the first of a new class of drugs that could actually cure the disease. Nearly a dozen new pharmaceuticals have followed since, but these treatments can cost as much as $85,000 annually, although healthcare plans and many consumers paid much less. Mavyret, a new drug released last summer, can address all forms of the disease at costs closer to $26,000 a year, according to reports.

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