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Officials say state Medicaid programs may be violating law by denying expensive medicines
In a sign of growing government interest in rising prescription-drug costs, federal officials on Thursday said state Medicaid programs may be violating federal law by denying patients expensive hepatitis C medications.
They also asked drug makers to provide information on their pricing arrangements with health insurers, which officials said could help ease the financial burden on state budgets.
The Centers for Medicare and Medicaid Services said in a notice to state Medicaid directors that some states may be “imposing conditions for coverage that may unreasonably restrict access” to hepatitis C drugs. Such restrictions may be “contrary to the statutory requirements” of a federal law requiring Medicaid programs to pay for all medically necessary treatments, defined as any use approved by the Food and Drug Administration or by certain medical guidelines known as compendia, the notice said.
CMS’s notice, which was posted online Thursday, said that some states have restricted use of hepatitis C drugs to Medicaid patients with severe liver disease and those who can prove they have abstained from drug and alcohol abuse. Patient advocates and doctors have long complained that such conditions aren’t included in the drugs’ FDA-approved prescribing labels.