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Federal Court Requires WA Medicaid to provide HCV Cure to Patients

Today federal district court Judge John C. Coughenour handed patients diagnosed with Hepatitis C virus an unmitigated victory, ordering coverage by the Washington Health Care Authority, the state Medicaid agency, of a cure for Hepatitis C, treatment needed by thousands of Washington Medicaid enrollees.

The patients had sued the Washington State Health Care Authority to get treatment with direct acting anti-viral medications, a newly approved cure for Hepatitis C. But the Washington state Health Care Authority limited access to the cure to only patients whose liver had been irreparably damaged by the disease, even though the scientific evidence shows that the cure is more effective and produces better health results, the earlier it is provided. The plaintiffs argued that forcing Medicaid enrollees to wait until their health worsens violates clinical guidelines of the American Association for the Study of Liver Diseases (AASLD). “[C]linicians should treat HCV-infected patients with antiviral therapy with the goal of achieving an SVR [sustained virologic response or cure], preferably early in the course of their chronic HCV infection before the development of severe liver disease and other complications.” See http://hcvguidelines.org/full-report/when-and-whom-initiate-hcv-therapy (emphasis added).

Judge Coughenour ruled that the Washington State Health Care Authority’s rationing policy violates the federal Medicaid Act, which promises that low-income patients on the program may have access to medically necessary treatment. He ordered that the Health Care Authority immediately stop applying its rationing policy. He ordered the agency to return to providing coverage for prescription medications to treat Hepatitis C without regard to the extent of a patient’s liver damage.

HCV is a communicable disease that causes chronic inflammation throughout the body of those infected and can lead to serious liver damage, infections, liver cancer and death. At least 20,000 people in the United States die each year due to liver disease caused by HCV. After one of plaintiffs’ counsel, Sirianni Youtz Spoonemore Hamburger filed similar lawsuits against Regence, Bridgespan and Group Health, all three private insurers eliminated similar exclusions from their health insurance policies. Washington state Health Care Authority, however, refused to do so, prompting the Plaintiffs’ Motion for Preliminary Injunction.

“This Order will save lives,” said Rick Spoonemore of Sirianni Youtz Spoonemore Hamburger, one of the plaintiffs’ counsel in the case. “The State’s exclusionary policy was put in place for one reason only – to save money. But saving money should never come at the expense of the health and lives of any patient, even if they are low-income and on Medicaid.”

“Thousands of Washington Medicaid enrollees infected with Hepatitis C virus can now get the cure they need,” said Amy Crewdson of Columbia Legal Services. “WHCA should never have put in place rationing of this treatment in the first place, as it had been sued for this same Medicaid violation before.” The State’s Medicaid Agency had been sued on at least two other occasions for attempting to impose cost-based rationing in its Medicaid program, in a case called Mead v. Burdman and a later contempt motion in the same matter.

“Medicaid programs across the country should consider Judge Coughenour’s Order and change their practices before they also get sued,” said Kevin Costello of the Center for Health Law and Policy Innovations at Harvard Law School. “Rationing policies like the one used by the Washington Health Care Authority are in place in dozens of states across the country. All of those policies are likely improper as well.”

View the preliminary injunction here.

View media coverage of the court's decision:

 

 

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