Monday's meeting of the Bioethics Interest Group will discuss whether it is ethical for state Medicaid programs to restrict coverage for new Hepatitis C medications on the basis of drug or alcohol use.
Roughly 3.5 million individuals are infected with Hepatitis C in the United States. For a long time, standard therapies for Hepatitis C, such as interferon, had a cure rate of 40-60% but terrible side effects that caused frequent treatment discontinuation. In the past several years, new medications, Direct-Acting-Antivirals, or DAA (brand names Sovaldi, Harvoni, Viekera Pak), have been developed that have near 100% cure rates for patients who follow a 12-week regimen of a daily pill. Side effects are comparatively minimal.
The new medications are available from the manufacturer for over $80,000 per person. Even after payer discounts, DAA are still extremely expensive. As a result, state Medicaid programs have been unable to bear the cost of covering DAA for all patients who have Hepatitis C. States have typically covered 2-5% of eligible patients in a given year.
This talk will discuss why the current restrictions are in place. The group will then explore whether any of those reasons for restricting access to care are justified, and whether the current substance use restrictions are ethically defensible.