Thousands of Indiana Medicaid recipients infected with Hepatitis C will soon be eligible to receive direct-acting antiviral medications, or DAAs, that have a greater than 90% rate of curing the disease. This is the result of an agreement recently approved by a federal court in a class action lawsuit filed by the American Civil Liberties Union of Indiana against the Indiana Family and Social Services Administration.
The lawsuit, filed in 2015, challenged the State’s criteria for determining who is eligible for Medicaid reimbursement of DAAs for treatment of Hepatitis C. The lawsuit claimed that the Indiana Family and Social Services’ policy violates federal Medicaid law by refusing to provide physician prescribed DAAs to treat early-stage Hepatitis C, based on criteria requiring that the disease reach a certain level of severity before treatment.
In November 2018, the parties proposed a settlement agreement that requires the agency to eliminate any restrictions based on the severity of the disease by July 1. That agreement was approved by the U.S. District Court for the Southern District of Indiana at a hearing on February 5, 2019. The agreement also requires the agency to provide treatment, even before July 1, to any person who possesses a co-morbidity that hastens the progression of the disease or who are actively symptomatic as a result of the disease.
“Federal law requires state Medicaid agencies to pay for medically necessary treatment, but Indiana Medicaid illegally denies a cure for Hepatitis C for reasons that are not medically justified,” said Gavin M. Rose, ACLU of Indiana Senior Staff Attorney. “With this agreement, the Indiana Family and Social Services will no longer restrict treatment for Hepatitis C.”
Hepatitis C is a life-threatening, communicable disease that attacks the liver. It is the deadliest infectious disease in the U.S., killing more Americans than the next 60 infectious diseases combined. Even in the initial stages of the disease, Hepatitis C can cause serious symptoms, including fatigue, joint pain, depression, arthritis, as well as an increased risk of heart attacks, diabetes, nerve damage, jaundice and various cancers. And studies have shown that early treatment has long-lasting benefits, including a decrease in mortality rate.
“This policy was withholding potentially life-saving drugs and forcing thousands of Hoosiers who cannot afford private insurance to live with the serious negative health effects of Hepatitis C,” said Jane Henegar, executive director of ACLU of Indiana. “By ensuring full access to Hepatitis C treatment, this agreement will save lives.”