Indiana agrees to provide Hepatitis C drugs to more Medicaid recipients

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The Indiana Lawyer on 2/19/2019 by Marilyn Odendahl

An agreement reached in federal court in February will allow Indiana Medicaid recipients infected with Hepatitis C to receive direct-acting antiviral medications, or DAAs, sooner rather than having to wait until the disease has significantly damaged their livers.

An order signed Feb. 12 by Senior Judge Sarah Evans Barker of the U.S. District Court for the Southern District of Indiana brings to an end a class action lawsuit filed in 2015 by the American Civil Liberties Union of Indiana. The ACLU had challenged the Family and Social Services Administration’s policy that had limited Medicaid reimbursement for DAAs only to Hepatitis C sufferers who were at a high risk for liver failure and liver cancer.

Under the settlement agreement, reached in November, the Family and Social Services Administration would eliminate by July 1 any restrictions based on the severity of the disease for Medicaid patients to receive a reimbursement for DAAs. Also, the reimbursement will now be made available to any Medicaid recipients whose liver damage is rapidly progressing or whose Hepatitis C is actively symptomatic.

Also, as part of the agreement, FSSA has agreed to pay the ACLU of Indiana $117,500 for attorney fees and costs in the case.

In response to the agreement being reached, the Family and Social Services Administration said it “continues to place a high priority on evidence-based care. Hepatitis C treatment is an essential service for Indiana Medicaid and we look forward to the opportunity to improve Hoosier outcomes.”

The original plaintiff, Sarah Jackson, is a Medicaid recipient in Allen County who was denied approval by the FSSA for a course of the medication Harvoni for her Hepatitis C. According to the complaint, a course of the drug could have cured her Hepatitis C and prevented Jackson from passing along the disease to her children. However, the disease had not progressed, so the FSSA turned down Jackson’s request.

Noting the FSSA’s practice of providing DAAs only to the sickest Hepatitis C patients, the complaint asserted the agency was denying access to a “potentially life-saving or life-sustaining drug to thousands of Hoosiers.” Also, the complaint charged the FSSA was violating federal Medicaid law by refusing to provide Harvoni even when the drug was “medically necessary.”

“This policy was withholding potentially life-saving drugs and forcing thousands of Hoosiers who cannot afford private insurance to live with the serious negative health effects of Hepatitis C,” Jane Henegar, executive director of the ACLU of Indiana, said in a statement.

“Federal law requires state Medicaid agencies to pay for medically necessary treatment, but Indiana Medicaid illegally denies a cure for Hepatitis C for reasons that are not medically justified,” Gavin Rose, ACLU of Indiana senior staff attorney, said in a statement. “With this agreement, the Indiana Family and Social Services will no longer restrict treatment for Hepatitis C.”