Medicaid policy leaves Hepatitis C patients untreated

By Megan Liz Smith, Michelle Stoddart, Meg Cunningham and Cecilia Cao


Terri Prugh and her father Richard laugh on their porch on Tuesday, Sept. 26, 2017 in Lenox, Missouri. Prugh also lives with her fiancé, and they are set to be married on November 18, 2017, two days after she finishes treatment.

For Missouri Medicaid beneficiaries with hepatitis C, getting treated can be tricky. The state will only cover the treatment if a patient’s condition has reached a certain level of severity. They claim the cost of providing treatment is too high to treat everyone who has the disease. Three Missourians under Medicaid who have hepatitis C, are suing the Missouri Department of Social Services for refusing to provide treatment. The plaintiffs say that withholding treatment costs more because of what it leads to, like cirrhosis, liver transplants, cancer and even death.


In the United States, up to 3.9 million people are infected with chronic hepatitis C, according to the Centers for Disease Control and Protection. Fortunately, there are now drug treatments available with an almost 100 percent cure rate. In the past five years alone, new drugs have come to the market that treat all six types of the virus.

While more treatment options are becoming available, they come at a price of upwards of $95,000. A single pill of Harvoni, a leading hepatitis C treatment, costs $1,125. Competition

Terri Prugh holds her treatment and diagnosis results for hepatitis C on Tuesday, Sept. 26, 2017 in Lenox, Missouri. The entire process, from her diagnosis to follow-up care, will take about six months. After she is finished with the 12 weeks of treatment, she will get an MRI of her liver every six months for the rest of her life.

is slowly driving prices down, but states are still having trouble affording the lifesaving treatment. In 2015, Missouri entered an agreement with Sovaldi, which reduced the price of the drug by 30 to 40 percent, according to the Department of Social Services.
Although the lower prices make the drug easier to afford, the Medicaid budget is tight.

“No one has an extra five or 10 percent of their budget just lying around,” Matt Salo, executive director of the National Association of Medicaid Directors, said.

Because of this, states set requirements for who they can and cannot treat. They do this by grading the severity of liver scarring.

“It’s called a Fibrosis Score, or F Score,” said Ghassan Hammoud, a hepatologist and gastroenterologist at the University of Missouri Hospital. “If you have a higher score, like F3 or F4, you’re on the verge of having your liver fail, getting liver disease, or even cancer. If the scarring is still in its early stages, like F0 or F1, that means there’s not much damage.”

The state tries to save money by only treating those with advanced scores. In Missouri,

Terri Prugh stands by her pond at her home in Lenox, Missouri on Tuesday, Sept. 26, 2017. Prugh is a Medicaid beneficiary receiving treatment for hepatitis C. She is in her seventh of 12 weeks of treatment for cirrhosis and hepatitis C. She said her diagnosis caught her by surprise after routine blood tests showed her liver enzymes had skyrocketed.

treatment is withheld until a patient has reached a score of F3, at which point severe liver damage has already occurred.

The Missouri Department of Social Services is being sued by three patients waiting for treatment under Medicaid. The plaintiffs argue that the state has an obligation to cover the cost of their treatment.

John Ammann, the attorney representing the plaintiffs, said it is proven that follow-up care is cheaper for the state if the disease is addressed early on. A recent study from Gilead Sciences, Inc. looked at this issue from a national level. They produce the hepatitis C drugs, Harvoni and Sovaldi, and wanted to find whether a “treat all” method really was cheaper. What they found was treating all eligible Medicaid patients with hepatitis C, regardless of the fibrotic stage, would result in 16,173 fewer hepatitis C related deaths and $3.8 billion in national savings.

“Collectively, most states are definitely relaxing their criteria. Some of that is in response to lawsuits, some of it is in response to the fact that prices are coming down,” Salo said.
The trial is set for February 2018. Many advocates hope the outcome of this case could change the status of thousands of patients waiting for treatment.

Terri Prugh and her father Richard stand on their porch on Tuesday, Sept. 26, 2017 in Lenox, Missouri. Prugh said living with her father is a challenge for her because she worries about exposing him to the hepatitis C virus. She said she takes many precautions like wearing gloves while she cooks and bleaching the shower every day to help ensure she keeps her father safe.

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