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Insurers want states to cover pricey hep C drugs

March 6, 2014 | By
Tools

New hepatitis C treatments could cost at least $200 billion in the next five years, prompting insurers to ask state officials to help pick up the tab.

Insurers that administer Medicaid plans, including Molina Healthcare, WellPoint and Aetna, have reached out to state agencies about how to afford covering the drug Sovaldi, which costs $84,000 per person, reported Reuters.

The actual amount of people with hepatitis C is unknown, so insurers can't estimate whether they will lose money by covering the medications. Persons newly infected with the hepatitis C virus usually are asymptomatic, so acute hep C rarely gets identified or reported, according to the Centers for Disease Control and Prevention.

The CDC recommends hepatitis C testing for persons born from 1945 through 1965 and patients with signs or symptoms of liver disease among others at increased risk. Screening efforts for hepatitis C have increased, Reuters noted, causing insurers to see a boost in these patients.

Molina--which administers Medicaid plans in 11 states--has asked state officials to directly cover the new hepatitis C drugs, while Aetna pays for Sovaldi as it negotiates with Medicaid programs throughout the country, Reuters noted. But states and Medicaid programs warn they don't necessarily have extra funds to cover such pricey drugs. And most Medicaid programs haven't yet decided whether they'll cover Sovaldi.

"We are sensitive to the potential that this is a meteor falling out of the sky and devastating a business model (for insurers) ... but I don't think we are there yet," Matt Salo, executive director of the National Association of Medicaid Directors, told Reuters.

To learn more:
- read the Reuters article
- check out the CDC facts

Related Articles:
EHRs improve identification, testing of infants at risk for Hep C
ACA coverage may be inadequate for chronically ill
Hep C 'serial infector' sentenced to 39 years in prison
UnitedHealth must pay $500M more in hep C case
Insurers shift prescription costs to members with drug tiers

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