After receiving a formal threat of litigation, officials at the Illinois Department of Health and Family Services (HFS) negotiated with Legal Council lawyers to end the department’s policy of rationing coverage of life-saving drugs to cure hepatitis C (HCV) for Medicaid participants.
This policy change comes after years of discussions and strategic advocacy to remove unnecessary and life-threatening barriers to the cure. Left untreated, hepatitis C can cause liver failure, liver cancer, and death. Prior to this change, Illinois Medicaid only paid for Direct Acting Antivirals (DAAs, a treatment that cures hepatitis C) for some people with hepatitis C:
- Only patients showing signs of severe liver disease were covered.
- Patients with a substance abuse disorder were not eligible for coverage.
- Patients who previously received partial or full DAA treatment but were not cured were not eligible for coverage.
“The expansion of the availability of hepatitis C therapy will have a great impact on the clients that we work with,” said infectious disease doctor Nancy Glick. “Removing the barriers to treatment will not only help the individual infected with HCV, it will have important public health implications for ending the epidemic for us all.”
More than 19,000 Illinoisans with hepatitis C are enrolled in the Medicaid program, but this number includes only individuals who know of their diagnosis: Only half of the 3.5 million people living with HCV nationwide are aware of their status. Meanwhile, Illinois Medicaid denied thousands of requests for DAAs, granting the cure to only a fraction of those eligible. Prior to the successful negotiations with HFS for this policy change, Illinois ranked #5 in states with the most restrictive eligibility policies for HCV medication.
The number of hepatitis C-associated deaths nationwide was greater than the number of deaths from 60 other infectious diseases combined (including HIV) in 2013. In just Chicago, HCV-related deaths have steadily increased since 2005. While Illinois Medicaid’s former policies put thousands of low-income Illinoisans at risk of illness or death, this new policy grants access to a simple, life-saving cure. We applaud the State of Illinois for this monumental change.
“Illinois is taking positive steps to cure HCV, which is huge for the HIV community,” said Tom Yates, Legal Council Executive Director. “It’s just a matter of organizations working together to make change happen.”
Thank you to our partners in this effort including Jenner & Block LLP, Center for Health Law and Policy Innovation of Harvard Law School, and AIDS Foundation of Chicago.
Read more in our press release and joint statement. Click here to view the new criteria posted by HFS.