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WASHINGTON – Jose Robles is the picture of health. And because of that, he has to remain sick, even though new drugs would likely cure him of the disease he’s had since birth.
Robles, born with hepatitis C, is currently asymptomatic, but when he tried to enlist in the Marines, they turned him down because his ailment made him a “liability.” Determined to make good on a promise to his honorably discharged brother, Robles spoke with his doctor who quickly prescribed Harvoni.
The drug – approved by the FDA in 2014 – has a 95 percent chance of curing hepatitis C within three months – and an estimated $94,500 price tag. Arizona’s Medicaid program will pay for the drugs, but Robles does not meet its strict restrictions on who qualifies for the costly drugs.
Because he’s not really sick, Robles will have to stay a little sick. And that makes him angry.
“Since I don’t show any signs of liver inflammation and I don’t have HIV or AIDS, they told me I couldn’t be processed until my symptoms got worse,” said Robles, 18, of Flagstaff. “At first, I didn’t feel anything about it, but now I’m angry.”
He’s not the only one: From doctors and patients to ethicists and actuaries, the debate over access to wonder drugs like Harvoni and Sovaldi for hepatitis C has spurred investigations, lawsuits and conversations about the restrictions that leave some patients without access to the newest treatments.
Dr. Anita Kohli of St. Joseph’s Hospital in Phoenix is all too familiar with that conflict. As an infectious disease specialist, she is used to prescribing treatments for hepatitis C that took up to 48 weeks to work and left patients “exhausted, like they had been through chemotherapy.”
She can prescribe drugs like Harvoni, but said “outdated” and “unprecedented” restrictions imposed by insurance companies keep “90 percent – maybe more” of her hepatitis C patients from being cured.
“The Medicaid guidelines are a little problematic … and need to be remedied,” Kohli said in a phone interview. “It’s all just an artificial barrier to treating the disease.”
But Matt Salo, the executive director for the National Association of Medicaid Directors, said that opening up access to everyone might work – but would dry up every state’s Medicaid budget in the process.
Read more of this excellent analysis here: http://cronkitenews.azpbs.org/2016/05/09/price-miracle-limited-access-hepatitis-c-drug-sparks-debate/