New York Insurers to Change Coverage of Hepatitis C Drugs--Update
April 26 2016 - 11:19AM
Dow Jones News
By Corinne Ramey
Seven health-insurance companies in New York will change their
criteria for covering costly drugs that cure chronic hepatitis C
under the terms of agreements with the office of State Attorney
General Eric Schneiderman.
The agreements, announced Tuesday, require the insurers to cover
hepatitis C medications for nearly all patients who have commercial
insurance plans in the state.
Last year, Mr. Schneiderman's office began an investigation into
coverage of drugs for chronic hepatitis C, issuing subpoenas for
documents and claims data to all commercial health insurers in the
state. The investigation showed a wide discrepancy in how companies
cover these drugs and found some insurers largely covered only
patients with advanced stages of the disease, the attorney
general's office said.
Five of the insurers denied from 30% to 70% of claims, the
office said.
Common hepatitis C drugs include Harvoni, manufactured by
pharmaceutical company Gilead Sciences Inc., which has a list price
of $94,500 for a typical course of treatment.
The insurers that reached deals with the attorney general's
office are Affinity Health Plan, Anthem Inc. subsidiary Empire
BlueCross BlueShield, Excellus BlueCross BlueShield, HealthNow New
York Inc., Independent Health Association Inc., UnitedHealth Group
Inc. subsidiary Oxford Health Plans, and MVP Health Care, the
attorney general's office said.
Under the terms of the agreements, the attorney general's office
said it would end its investigation into these plans.
New York Health Plan Association, which represents state health
insurers, said coverage guidelines continue to evolve.
"HPA believes New York should focus on affordability by taking a
more aggressive position on the excessive pricing of these
Hepatitis C drugs, " President and Chief Executive Paul Macielak
said in a statement.
MVP Health Care said the agreement is consistent with principles
and practices it already has in place. The other six insurers
declined to comment or didn't respond to requests for comment.
Mr. Schneiderman's office said EmblemHealth Inc. and Aetna Inc.
were among the insurers it found consistently provided coverage to
patients at earlier stages of the disease.
Doctors and patient advocates nationwide have accused health
insurers of regularly denying coverage until patients' livers are
damaged. Health insurers say the medications are prohibitively
expensive, and covering such drugs can inhibit their ability to
keep other costs low.
A Gilead spokeswoman said it gives insurers steep discounts. The
drug is cost-effective because it saves long-term treatment costs,
the spokeswoman said.
As part of their agreements, these seven insurers must cover
medication for patients who don't have advanced disease and can't
deny treatment for patients based on alcohol or drug use.
From 3.5 million to seven million people nationwide are
estimated to have chronic hepatitis C, said Brian Edlin, a
professor at Weill Cornell Medical College.
Hepatitis C is typically spread through blood contact, such as
from needle use when injecting drugs.
Dr. Edlin said the agreements were a big step in the right
direction, but noted they focused on commercial insurers.
"Medicaid insurers are continuing to impose these severe
restrictions and onerous prior authorization processes," he said.
"Consequently, this disease will become increasingly a disease of
the poor, and health inequities that already exist will
sharpen."
The state's Department of Health said Medicaid insurers are
updating their plans in consultation with the department's
recommendations to reduce restrictions consistent with changes
being made by commercial plans.
Write to Corinne Ramey at Corinne.Ramey@wsj.com
(END) Dow Jones Newswires
April 26, 2016 12:04 ET (16:04 GMT)
Copyright (c) 2016 Dow Jones & Company, Inc.
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