Kansas has agreed to settle a lawsuit alleging the state’s Medicaid program sets too many barriers for hepatitis C patients to receive potentially life-saving but expensive medications.
Terms of the settlement have yet to be finalized, but the parties filed a notice with the court Tuesday afternoon that they had resolved the case after mediation.
“I feel comfortable saying we have a path forward to making sure all people on Medicaid with hep C will be treated, regardless of their fibrosis score,” said Lauren Bonds, legal director of the ACLU of Kansas, which filed the lawsuit on behalf of two Medicaid patients.
Jeff Anderson, secretary of the Kansas Department of Health and Environment and a defendant in the lawsuit, said the parties had reached an agreement in principle to resolve the issues in the case.
“There are still a number of steps that need to be taken to implement the parties’ agreement,” he said in an email.
Hepatitis C is a contagious liver disease that can range in severity from a few weeks’ duration to a chronic condition causing severe liver damage and even death. Most people become infected by sharing needles, syringes or other equipment to inject drugs.
The lawsuit, which was filed in February, alleged that KanCare – Kansas’ privatized Medicaid program – denied Medicaid patients coverage for direct-acting antiviral drugs that have a 90 percent cure rate for hepatitis C.
Before the advent of direct-acting antiviral drugs, treatments had cure rates of less than 50 percent and more extensive side effects. The direct-acting antiviral drugs are extremely costly but are now the standard of care.
KanCare limits coverage to patients with fibrosis scores — which measure the health of the liver — of F3 or F4. F4 indicates significant liver damage or cirrhosis.
KanCare also denies coverage to patients who test positive for alcohol or illicit drug use. Patients have to undergo six months of “abstinence” testing before KanCare considers covering the medications.
The Kansas lawsuit is one of several nationwide challenging state Medicaid programs’ refusal to cover the drugs’ costs.
Other lawsuits have challenged state prisons’ refusal to provide the drugs to inmates. One of them, also filed by the ACLU, alleges the Missouri Department of Corrections has systematically denied treatment to prisoners with hepatitis C.
Dan Margolies is a senior reporter and editor at KCUR. You can reach him on Twitter @DanMargolies