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Deal requires seven insurers to cover the drugs for most patients with commercial insurance plans
Seven health-insurance companies in New York will change their criteria for covering costly drugs that cure chronic hepatitis C under the terms of agreements with the office of State Attorney General Eric Schneiderman.
The agreements, announced Tuesday, require the insurers to cover hepatitis C medications for nearly all patients who have commercial insurance plans in the state.
Last year, Mr. Schneiderman’s office began an investigation into coverage of drugs for chronic hepatitis C, issuing subpoenas for documents and claims data to all commercial health insurers in the state. The investigation showed a wide discrepancy in how companies cover these drugs and found some insurers largely covered only patients with advanced stages of the disease, the attorney general’s office said.
Five of the insurers denied from 30% to 70% of claims, the office said.
Common hepatitis C drugs include Harvoni, manufactured by pharmaceutical company Gilead Sciences Inc., which has a list price of $94,500 for a typical course of treatment.
The insurers that reached deals with the attorney general’s office are Affinity Health Plan, Anthem Inc. subsidiary Empire BlueCross BlueShield, Excellus BlueCross BlueShield, HealthNow New York Inc., Independent Health Association Inc., UnitedHealth Group Inc. subsidiary Oxford Health Plans, and MVP Health Care, the attorney general’s office said.
As part of their agreements, these seven insurers must cover medication for patients who don’t have advanced disease and can’t deny treatment for patients based on alcohol or drug use.