Litigation Forcing States to Stop Restricting Hepatitis C Treatment for Medicaid Recipients

The following opinion is written by Sonia Canzater, an associate with the O’Neill Institute for National and Global Health Law at Georgetown University.

Last week, a federal judge in Washington state ruled that the state Medicaid authority cannot place undue limitations on access to hepatitis C (HCV) drugs for patients, as Medicaid has the duty to provide “medically necessary” treatment to the patients it covers. Until this ruling, many states, including Washington, citing the high cost of the latest direct acting antiviral (DAA) drugs to treat HCV and justification to restricted Medicaid recipients’ access to these drugs only to patients whose liver has already sustained serious damage because of the illness.

On June 3, 2016, under the looming threat of litigation and in acknowledgment of the Washington state holding, the Delaware Division of Medicaid and Medical Assistance changed their policy of rationing Hepatitis C drugs to no longer restrict treatment only to those with significant liver damage or cirrhosis.

These changes are a

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