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Devin D. Thorpe

Devin Thorpe

Marking World Hepatitis Day 2016, Amida Care Welcomes Medicaid Policies on Funding HCV Drugs

As World Hepatitis Day is observed on July 28, Amida Care, New York State’s largest Medicaid HIV special needs health plan, is taking pride in its local contributions to the global drive toward eliminating the public health threat of viral hepatitis by 2030.

Nationally, up to 40 percent of people living with HIV are co-infected with Hepatitis C virus (HCV), which can cause chronic liver infection, serious liver damage, and even liver failure. HIV co-infection more than triples a person’s risk for liver disease and liver-related death from HCV.

Until recently, HCV was an incurable chronic infection for most people with HIV. Across Amida Care’s New York City service area, the organization found that at least 30 percent of its 6,000+ members were co-infected. Then, in 2013, costly but curative HCV medications were approved by the Food and Drug Administration and came on the market.

Since then, Amida Care has been in the process of covering treatment for hundreds of its co-infected members. Of those who already have completed the 12- to 24-week drug regimen, 400 have been cured of HCV.

Amida Care has achieved successful clinical outcomes while also reducing spending on inappropriate prescribing, dispensing and use of expensive HCV medications. Amida Care has advocated for providing appropriate Medicaid drug coverage for these medications to all who test positive for HCV. Each daily pill can cost up to $1,000.

In late April, NYS Attorney General Eric Schneiderman reminded state Medicaid insurers of their obligation to follow the federal Medicaid guidelines announced on Nov. 5, 2015 by the Centers for Medicare & Medicaid Services. In these guidelines, CMS committed to providing medically necessary drug coverage to all those who are eligible for Medicaid and test positive for HCV.

Amida Care understands the importance of providing access to HCV medications and prioritizing early treatment. In affirming this Medicaid policy, Schneiderman echoed the approach to care that was voiced several years ago by Amida Care’s Chief Medical Officer Jerome Ernst, M.D., and other physicians who worked with NYS Medicaid officials to review criteria for coverage of the pricey but effective new HCV medications.

As Terry Leach, Pharm.D., Amida Care’s Vice President of Pharmacy, puts it: “People need access to these drugs. It’s about doing the right thing and keeping members healthy. Cost reductions will follow.”

Others in the medical community, including Ken Davis, M.D., President and Chief Executive of Mount Sinai Health System, have also been outspoken. Commenting earlier this month on the pricing of HCV and other specialty drugs, Davis said pharmaceutical companies are “breaking their social contract with patients and [U.S.] taxpayers,” by charging “prohibitive specialty-drug prices that exceed what’s needed for a return on their investments.”*

Amida Care’s role in curing HCV among New Yorkers on Medicaid who are co-infected with HIV is expensive, but it saves lives and saves money in the long run by reducing hospitalizations and end-of-life care, among other medical expenses. In addition, more people with access to medication means a greater volume of revenue.

The resources and treatments to cure HCV are now available and must be accessible to all, as the NYS Attorney General recently underscored.

Ultimately, these efforts also further the global initiative of World Hepatitis Day: to eliminate this public health threat worldwide by 2030.

*Crain’s Health Pulse (Crain’s New York Business), July 6, 2016

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