Pennsylvania State Medicaid program wrestles with high cost of hepatitis C treatment

reating Medicaid beneficiaries diagnosed with a hepatitis C virus (HCV) infection has grown more expensive due to new drugs on the market with a higher cure rate. In Pennsylvania, the state Department of Human Services' Medicaid program has seen its bill for HCV drug treatment rise from $33.7 million to $138.1 million in 2 years.

Treating Medicaid beneficiaries diagnosed with a hepatitis C virus (HCV) infection has grown more expensive due to new drugs on the market with a higher cure rate. In Pennsylvania, the state Department of Human Services' Medicaid program has seen its bill for HCV drug treatment rise from $33.7 million to $138.1 million in 2 years. Since 2013, Pennsylvania's annual cost per patient has more than doubled, from $33,734 to $76,425, and the number of patients being treated may soon grow. State guidelines currently call for providing the new drugs once a Medicaid beneficiary with HCV has developed advanced fibrosis of the liver, or if the infection has progressed to life-threatening cirrhosis. A 2015 report found that 30 other states and Washington, DC, use the same criteria; but CMS has indicated that may violate federal law, noting that such coverage restrictions are appropriate only when the drug is not a "medically accepted indication" for the diagnosis. A state advisory committee recently recommended that Pennsylvania's Medicaid program expand treatment approval criteria to anyone diagnosed with hepatitis C, even if they have no symptoms.