U.S.: Denying Medicaid Patients Access to Hep C Treatments is Wrong and Illegal

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Elizabeth G. Taylor
Executive Director of the National Health Law Program (NHeLP)

Imagine you are diagnosed with cancer. Your doctor tells you that your cancer is completely curable. But unfortunately, the cure is very expensive. It is so expensive that your insurance won’t pay for the cure until your cancer has advanced to stage three. You will have to suffer for months — possibly even years — before you have a chance at a cure. You may experience serious symptoms while you wait for a cure — fatigue, organ damage and depression. Your insurance plan may pay for treatments that ameliorate some of your symptoms, but they will not cure the underlying disease until you get very, very sick. And when you do get the cure, it won’t undo a number of problems that you developed along the way. This scenario sounds unfair.

But this is nearly the exact scenario that states are imposing on their poorest residents. A series of new, breakthrough treatments for Hepatitis C was approved by the FDA starting in late 2013. But the cost of treatment was set very high, more than $80,000 for a course of treatment. Despite outrage from patients and advocates, drug companies continued charging thousands of dollars for these treatments. While the treatments are highly effective, the high cost put a cure out of reach for most people.