Kansas has agreed to cover the cost of drugs to treat Medicaid patients with chronic hepatitis C without subjecting them to a lengthy list of requirements.
A legal settlement, which awaits final court approval, resolves a class action lawsuit alleging the state made it too difficult for hepatitis C patients to receive the potentially life-saving treatments.
The parties first notified the court in July that they had resolved the case after mediation. On Tuesday, the court set deadlines for approval of a final settlement.
“Essentially, the agreement is that all hep C patients who use Medicaid to get their drugs will be entitled to Mavyret or Harvoni, the two curative drugs, regardless of their fibrosis score,” said Lauren Bonds, legal director of the ACLU of Kansas, which along with the Shook Hardy & Bacon law firm, sued Kansas officials over the state's hep C treatment guidelines in February.
Fibrosis scores measure the health of the liver. Scores range from F0, referring to mild or no scarring of the liver, to F4, referring to significant liver damage or cirrhosis. Kansas’ privatized Medicaid program, known as KanCare, had limited coverage to patients with a fibrosis score of F3 or F4.
Theresa Freed, a spokeswoman for the Kansas Department of Health and Environment, confirmed that Kansas has stopped limiting coverage to patients with F3 or F4 scores.
The state had imposed other conditions for treatment as well, including denying direct-acting antiviral drugs, the current standard of care, to patients who tested positive for alcohol or illicit drug use. In addition, patients had to undergo six months of “abstinence” testing before KanCare would consider covering the drugs.
Bonds said the settlement resolves all the claims laid out in the lawsuit.
KanCare has about 360,000 enrollees. The U.S. Census Bureau in 2014 estimated that about 35,000 Kansans had hepatitis C, but it’s not known how many of them are enrolled in KanCare. The lawsuit estimates the number to be in the thousands.
“I think the law is very clear on this front,” Bonds said. “We’re one of probably 15 cases on this issue that have been filed and there’s been a very clear trend of how they’re being resolved — and that’s in favor of the plaintiffs.”
Many states balked at paying for the high-priced drugs and limited treatment for Medicaid patients and prison inmates. But recent court decisions have ruled that states cannot deny treatment because of the drugs’ costs.
Most recently, a federal judge in Indiana found that withholding hepatitis C treatment from prison inmates violated the Eighth Amendment’s “cruel and unusual punishments” clause. Similar rulings have been handed down or settlements reached in other states, including Florida, Massachusetts, Michigan, Washington and Colorado.
A lawsuit against Missouri was dropped in November 2017 after the state agreed to cover the cost of direct-acting antiviral drugs.
Hepatitis C is a contagious infection that can cause severe damage to the liver and even death. The Centers for Disease Control and Prevention estimates that between 2.7 million and 3.9 million people in the United States have chronic hepatitis C. Most people become infected by sharing needles, syringes or other equipment to inject drugs.
Until recently, there was no effective treatment for chronic hepatitis C infections. But in 2013, the U.S. Food and Drug Administration approved a new class of highly effective direct-acting antiviral drugs that have few side effects and boast a cure rate of more than 90 percent.
The drugs are extremely expensive. Mavyret runs about $26,400 per treatment course, before discounts. And Harvoni runs about $94,500 per treatment course, also before discounts.
Bonds said her understanding is that the state has funding in place to cover the drugs.
“We were assured about that, but don’t know a ton of the specifics,” Bonds said.
U.S. District Judge Daniel D. Crabtree must approve the settlement, final details of which are being hammered out.
Jennifer Montgomery, a spokeswoman for the Kansas Attorney General’s office, which defended the lawsuit, said work on the settlement was proceeding and the office was “optimistic about getting it resolved.”
Dan Margolies is a senior reporter and editor at KCUR. You can reach him on Twitter @DanMargolies.