Arizona Medicaid program limits coverage for Hep C drug
PHOENIX - Arizona's Medicaid program is joining some other states in limiting which patients can receive an effective but expensive new drug for hepatitis C.
Arizona's program recently told a legislative oversight committee that it costs taxpayers $80,000 to $150,000 per patient to provide Sovaldi to people enrolled in the program, the Arizona Capitol Times reported.
The Arizona Health Care Cost Containment System has thousands of patients diagnosed with hepatitis C, but so far the program is
providing coverage of
Sovaldi for only 180 people under a stringent screening process.
Under the state's criteria, people provided coverage for the $1,000-per-pill drug must be in late stages of liver scarring from hepatitis and must be drug free.
AHCCCS expects the drug to increase state spending by $7.7 million in the just-begun federal fiscal year to cover only the sickest people who meet strict eligibility requirements. The total cost is estimated it $32 million, but most is covered by federal matching funds.
The U.S. Food and Drug Administration approved the drug for sale in December 2013.
Rep. John Kavanagh, R-Fountain Hills, said legislators were surprised to learn about the high cost of the drug and its potential impact on the budget.
"This was a surprise to all of us because this was not something that occurred due to a bill or to the budget," Kavanagh said.
Carol Peters, a nurse practitioner with the University of Arizona Liver Research Institute, said AHCCCS had approved Sovaldi treatment for a few of the institute's patients who weren't in the later stages of the disease, but then declined all coverage for a few months while it worked out its coverage criteria.
"I don't know of any other disease where a patient has to get worse before being treated for it," Peters said.
There are other possible treatments for hepatitis C but they take longer to work and have more side effects.
Hepatitis C is a public health concern because the disease can be transmitted by contact with infected blood, by drug users sharing needles, and sometimes through sexual activity. Many people are unaware that they carry the virus. Health officials advise all baby boomers to get tested.
Other states limiting coverage for Sovaldi include Oregon and Illinois.