Earlier this month, the Department of Human Services (DHS) announced that it will change Pennsylvania’s Medicaid (MA) policy to expand coverage of drugs that treat the Hepatitis C (HCV) virus. DHS will soon start to phase out the coverage restrictions that largely limit HCV treatments to individuals with liver damage.
Under the new policy, DHS will amend its coverage guidelines for HCV treatment to authorize the drugs for beneficiaries with liver damage (“fibrosis”) scores of F1 or higher starting on July 1, 2017. In phase two, it will remove the disease severity restrictions entirely beginning on January 1, 2018. These changes apply to both fee-for-service Medicaid and the HealthChoices managed care program. A fibrosis score measures the amount of scarring to the liver caused by the Hepatitis C virus. Results are measured on a scale of F0 through F4, with F0 indicating no scarring and F4 being the most severe disease progression. These changes follow the clinical recommendations presented a year ago by DHS’ Pharmacy & Therapeutics Committee as well as current medical guidelines.
PHLP applauds the Department for increasing access to these life-changing medications. PHLP, along with attorneys from the Center for Health Law & Policy Innovation of Harvard Law School, Community Legal Services, and Kairys, Rudovsky, Messing & Feinberg notified DHS in 2016 of their intent to file litigation unless Pennsylvania's Medicaid program removed its disease severity restrictions from the coverage guidelines.