NJ Gives Medicaid Patients with Hepatitis C Earlier Access to Life-Saving Drugs

Lilo H. Stainton | July 11, 2018 | Health Care
Change means severe liver damage might be avoided. Up to now, patients were only covered for treatments after damage was evident

Credit: University of New South Wales
Hep-C drugs
Tens of thousands of New Jersey Medicaid patients diagnosed with hepatitis C will no longer have to wait until they have liver damage for their insurance to cover potentially life-saving medical treatments, thanks to a new state program and public funding that could also reduce the spread of the infectious disease.

State Department of Human Services Commissioner Carole Johnson announced yesterday that, with the fiscal year 2019 budget recently approved, New Jersey has set aside more than $10 million in state and federal dollars for prescription drugs to help prevent liver destruction associated with hep-C. Until now, these treatments were only available to Medicaid patients who already showed some level of fibrosis, or liver damage.

The policy change — something that has been embraced by a growing number of states and triggered widespread praise among Garden State stakeholders — comes as hep-C diagnoses are on the rise, due in part to infections associated with IV drug use, which has grown as part of the nation’s opioid epidemic. In addition, the disease is more common among the massive, aging baby-boom generation, who are six times more likely to be infected than those in other age groups.

Carole Johnson, commissioner of the Department of Human Services
“We can cure hepatitis C and help combat the spread of new infections, and with this major policy change our administration is making clear that we are committed to doing both,” said Johnson, who outlined the potential move at a public health conference earlier this year. “This is a welcome and long-awaited new direction for New Jersey.”

169,000 in NJ have hep-C

There are now 169,000 New Jersey residents — including at least 3,600 on Medicaid — likely infected with hep-C, a viral liver infection transmitted through contaminated blood and other bodily fluids that can lie dormant for years before causing cirrhosis or cancer, or forcing the patient to undergo a liver transplant. The high rates among baby boomers reflects the fact that they grew up in a time when less was known about safe sex and injection practices, and blood transfusions were not routinely screened.

In the Garden State, blood tests to detect hep-C became standard in the early 1990s and a wider understanding about the danger of HIV/AIDs and other public health helped reduce the spread of the disease. A handful of community-based needle exchange programs in urban hubs have also cut into these infection rates, but there has been limited funding and institutional support for these efforts.

Researchers have found that in recent years infection rates have begun to tick up again, particularly among young, suburban opiate addicts, whose hep-C rates jumped 13 percent between 2006 and 2012, according to a study by Princeton House, the behavioral healthcare arm of the Princeton Healthcare System. More than four in 10 of the heroin addicts they screened tested positive for the disease.

“Clearly, this is a long-needed policy change that will prove beneficial to many New Jerseyans,” DHS commissioner Johnson said.

To help combat this spread, lawmakers have in recent years introduced measures to expand blood-testing requirements, particularly among baby boomers. Both Senate health committee chairman Joseph Vitale (D-Middlesex) and Assembly health committee chairman Herb Conaway (D-Burlington), are backing bills that would do so, but the proposals differ on what providers would need to offer the screenings.

Several new pill-based treatments

But experts said it is also critical to expand access to a new class of hep-C drugs that can actually cure the disease. Until 2011, treatment options were limited, and most patients were forced to undergo a long course of IV medication that could only deter permanent liver damage. However, federal officials have since approved nearly a dozen pill-based treatments — including the popular brand-name drug Harvoni — that, while costly, can actually cure the disease; these tend to last eight to 12 weeks and can cost between $26,000 and $95,000 over this time.

“The funds provided by the administration will ensure that all New Jerseyans have access to live-saving hepatitis C medication immediately upon diagnosis,” said Kathy Ahearn-O’Brien, executive director of the Hyacinth AIDS Foundation, which has worked with Vitale over the years to expand preventive measures and treatment coverage. “As drug treatments have improved dramatically over the past few years, it makes absolute sense to treat immediately and not wait for the disease to progress to the point that an individual’s quality of life has been severely debilitated,” she said.

The move also was praised by Roseanne Scotti, New Jersey director for the national Drug Policy Alliance, and Joshua Spielberg, chief counsel for the Health Care Access Project at Legal Services New Jersey, which had advocated for the change. “It will save lives and save money for the NJ Medicaid program over time,” Spielberg said in a press release distributed by the DHS.

The department launched the policy change earlier this year and the final budget for FY 2019 included $2.2 million in state funding for the program, enough to generate a federal match of $7.9 million, according to the DHS. (The match ranges from 50 percent to over 90 percent, depending on how the individual patient qualifies for the Medicaid program; those who are eligible as a result of the Affordable Care Act’s expansion are eligible for a much higher match.)