Tag Archives: Pennsylvania

Pennsylvania Medicaid Opens HCV Treatment to Virtually All HCV Patients

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

On May 16th, 2017, Pennsylvania’s Department of Human Services (DHS) announced changes to the state’s Medicaid policy that will expand coverage to treat virtually all enrolled clients living with Hepatitis C (HCV). Beginning July 1st, 2017, HCV-infected beneficiaries with liver scoring of F1 will become eligible for treatment coverage for the newer Direct Acting Agents (DAAs) that are highly effective, easily tolerate, and also very expensive. Beginning January 1st, 2018, clients with liver scoring of F0 will become eligible for treatment coverage. Prior to the July 1st policy change, treatment coverage will be available only to clients whose liver scoring ranges F2 to F4, unless other mitigating complications exist that warrant immediate treatment.

These changes come in response to a number of factors, most notably the 290% increase in new HCV infections between 2014 and 2015 reported by the CDC earlier this month. The deciding factor in this case, as in many other state Medicaid decisions, was the threat of a class action lawsuit. Attorneys from the Center for Health Law & Policy Innovation at Harvard Law School, the Pennsylvania Health Law Project, Community Legal Services, and Kairys, Rudovsky, Messing, & Feinberg, LLC sent a formal demand letter in late 2016 on behalf of their clients, Pennsylvania Medicaid recipients. This letter notified DHS that unless it agreed to remove “categorical coverage exclusions” of HCV medical cures from its Medicaid policy, the state could face a Federal class action law suit (Harvard Law School, 2017).

For the uninitiated, a little explanation is likely in order on the topic of “F scoring.” The “F” stands for fibrosis – the thickening and scarring of connective tissue, usually the result of injury. In relation to the liver, F scoring describes the length in expansion of fibrotic areas between portal tracts (also known as “portal triads”), and these changes are staged at F0 (No fibrosis) to F4 (Cirrhosis) (Hepatitis C Online, 2015). Patients with F4 Cirrhosis is characterized by a loss of liver cells and irreversible scarring of the liver. A healthy liver regulates the composition of blood, including the amounts of sugar (glucose), protein, and fat that enter the bloodstream. It also removes bilirubin, ammonia, and other toxins from the blood (WebMD, n.d.). A cirrhotic liver cannot properly perform these functions, leaving the patient susceptible to numerous painful and life threatening illnesses and side effects of failing or failed liver function.

The changes to Pennsylvania’s Medicaid program make it one of the first in the nation to adequately address the burgeoning HCV epidemic by treating patients early in the disease cycle. While the newer DAA drugs are all very expensive, the cost of curing patients outright, rather than continuing to pay for their long-term health degradation while waiting for their liver to become scarred enough to treat their HCV. Aside from being costly, it is also inhumane. While HIV patients underwent similar treatment in relation to the recommendation of when they begin Antiretroviral Therapies (ARTs), eventually we came to the realization that treating the disease early would result in fewer long-term complications for HIV patients. This way of thinking in terms of HCV patients is likelier to come more quickly, now that we have medically curative treatments.

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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Pennsylvania: HB 2003

By: Marcus Hopkins, HEAL Blogger

The HEAL Blog has consistently advocated for common sense legislation that promotes for better health outcomes, particularly (and specifically) as it relates to Hepatitis C screening. In the course of our advocacy, we have covered Florida legislation (CS/HB 0465) that would require specific persons to be offered HCV testing with every visit to a healthcare facility; HB 0465 is now in the Health Care Appropriations Subcommittee.

Rep. Matthew E. Baker, Pennsylvania General Assembly

Rep. Matthew E. Baker, Pennsylvania General Assembly

On March 20th, WESA, Pittsburgh, PA’s National Public Radio station, posted an article stating that Pennsylvania Representative Matt Baker (R-Bradford) has submitted a similar piece of legislation in Pennsylvania.

Bradford’s bill would require health care providers to offer HCV testing to Baby Boomers – those born between 1945-1965 – in an effort to stem the rise of HCV infection in the state. The legislation, HB 2003, provides for hepatitis C testing and treatment and for duties of the Department of Health.

“By increasing testing opportunities, this legislation will insure that more individuals living with hepatitis C can become aware of their infection status, get available treatment and take steps to prevent transmission,” Baker said.

The CDC estimates that nearly 75% of all HCV cases in the country reside in this age demographic. This is problematic – a large percentage of this population has not yet aged into Medicare eligibility, and this bill is designed to serve as a preventative measure that could save untold billions in the future.

As with my previous position concerning Florida’s legislative effort to address the burgeoning HCV problem, I must once again pose the question, “Why just this population?”

Though infection rates currently point to the vast majority of cases being present in the Baby Boomer generation, are other generations and demographic groups any less susceptible to the ravages of this virus? Would requiring physicians and other health care professionals to offer the same testing opportunities to every patient be any more time consuming or costly? I would wager not.

What’s good for the goose is good for the gander – if we focus our testing and prevention efforts on only one segment of a population, we do a disservice to others. While the PA legislation is a good step forward, it would behoove us, as advocates, to urge our legislators to expand the provision to include all age ranges.

Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates.

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