Starting October 1, Michigan Medicaid will expand coverage for a new class of hepatitis C drugs. A twelve week course of treatment with the new direct-acting antiviral drugs clears the virus completely in most patients.
Michigan's Medicaid system limits access to the drugs to those who have later stage liver scarring. Liver scarring is staged from F0 to F4. Currently, only patients with scarring from F2 to F4 were eligible for the drugs. Beginning on October 1, patients with milder F1 liver scarring will also be able to receive treatment.
Dr. Eden Wells is the state's Chief Medical Executive. She says, “As costly as the medications are, the gain and preventing people from having progressive end stage liver disease or liver cancer and many of the other outcomes of hepatitis C make this a worthwhile investment.”
Next year, coverage will expand again to include patients staged F0. Those patients are in the earliest stages and have no scarring at all.
The drugs first came out in 2011, but they’ve come with a hefty price tag. People most likely to have hepatitis C include people with a history of injection drug use, people with HIV, babies born to mothers with hepatitis C, incarcerated people, and people who have received tattoos from unlicensed practitioners.
Those people, according to Wells, may be overrepresented in the Medicaid population. Many states, including Michigan, have wrestled with how to pay the high initial up front cost to provide the new drugs to every Medicaid recipient who needs them.
Wells says the total cost for Michigan will range from $24 million to $146 million to expand to F1 and F0 treatment. However, she says market forces may already be driving costs down.