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A new study that projects what could happen if Pennsylvania covered the costly treatment of hepatitis C for everyone in Medicaid yields some surprises for policymakers nationwide: Few lives would be saved. Some patients might actually fare worse. The federal government would likely reap savings, at the expense of the states.
The counter-intuitive findings from the University of Pittsburgh may become part of pitched debates in state capitols and the incoming administration in Washington over health-care costs.
Hepatitis C is an especially difficult issue. An estimated 3 million Americans are infected with the blood-borne virus but most have no idea until liver problems develop after decades. Highly effective treatments have come on the market only within the last few years and cost tens of thousands of dollars.
Medical guidelines issued last year say that anyone who is sick should be treated. But state treasuries can’t afford it, and patients report being told that they’re “not sick enough” for the medication. A state advisory panel recommended in May that Pennsylvania’s Medicaid program, which has fewer restrictions than most states, cover treatment for anyone who is infected. No decision has been announced.
The new findings, published this week in the journal Healthcare, are based on complex modeling of multi-year Medicaid claims but are especially influenced by two factors, senior author Walid Gellad said in an interview Thursday:
- The disease progresses slowly. As a result, many of those with chronic hepatitis C — Baby Boomers are disproportionately infected — will have aged out of Medicaid, which is jointly funded by the state and federal governments, and into the fully federal Medicare program in time for treatment to prevent serious complications.
- Medicare already covers treatment for all participants who are infected. The program spent an estimated $9 billion last year on hepatitis C drugs alone, double the 2014 figure.
Gellad, an associate professor of medicine and codirector of Pitt’s Center for Pharmaceutical Policy and Prescribing, said the study was the first to consider the interplay between Washington and the states.