WASHINGTON (AP) — Confronting the consequences of high-priced drugs, the Obama administration Thursday pointedly reminded states that they cannot legally restrict access by low-income people to revolutionary cures for liver-wasting hepatitis C infection.
The federal Centers for Medicare and Medicaid Services also sent letters to several drug manufacturers, requesting details of what they are doing to make their medications more affordable. Among the companies getting federal letters was California based Gilead Sciences, maker of market-leading Harvoni.
The moves echoed government pressure decades ago to make sure that low-income people covered by federal-state Medicaid programs had access to ground-breaking HIV treatments. It’s coming at a time the cost of prescription drugs is the leading health care issue for the public, according to opinion polls.
Hepatitis C is a viral illness that affects some 3 million people in the U.S. and claims more lives here than AIDS. Patients say it feels like a bad flu that never goes away. While the disease advances gradually, it can ultimately destroy the liver, requiring a transplant to save the patient’s life.
Previous treatments were hit and miss, and many patients couldn’t tolerate the side effects. With new drugs like Harvoni and Viekira Pak, patients finally have a choice among highly effective cures with minimal side effects. But with a course of treatment priced at around $100,000, the costs are straining government programs and private insurers alike.
In a notice to state Medicaid directors, the administration reminded states of their legal obligations to cover prescription medications for the poor.
Federal officials said they are concerned that some states are restricting access “contrary to ... statutory requirements” by “unreasonably” imposing limitations on which patients can get the new drugs.
They questioned requirements by some states that patients must have advanced liver disease first before they can get the cure. Since the new drugs cure hepatitis C, doctors say such restrictions don’t make sense from a clinical perspective. Federal officials also cited requirements by some states that patients abstain from illegal drugs and alcohol as condition of getting treatment.
The administration also requested explanations from drug companies that make, or are working on, breakthrough treatments. Although Medicaid programs are entitled to substantial savings from drug makers, that hasn’t been sufficient with the new hepatitis C drugs. Officials also asked for details on what the companies are doing to help states cover the cost of their medications.