The American Civil Liberties Union is suing Colorado Medicaid over denying Coloradans access to a drug with a 90 percent success rate in treating hepatitis C, the Denver Post reports.
Here’s what you should know.
1. Medicaid allegedly denied a man and other Coloradans access to the drug because "he has not yet suffered measurable and potentially irreversible liver damage."
Medicaid covers the 12-week, $40,000 prescription only for patients who have reached stage two liver scarring. Private insurers cover the treatment regardless.
2. The Colorado Department of Health Care Policy and Financing recently relaxed the coverage from people who were at stage three scarring to stage two following criticism and a recommendation to do so from the state drug review board.
The ACLU and the Denver Health Medical Center both have been vocal critics of the department and this policy.
3. While revising the policy, the department also expanded its coverage to women who are attempting to become pregnant, and loosened a restriction preventing chronic substance abusers from receiving the drug.
4. ACLU of Colorado’s legal director Mark Silverstein said the expansion didn’t go far enough and said the restrictions are endangering a population with a treatable disease.
The lawsuit said denying the drug to Medicaid users while a population with private insurance can have access to it is "illegal and against federal and medical guidelines."
5. Critics of the policy also take issue with the women seeking pregnancy clause because of questions over the burden of proof.
6. The class-action suit is seeking a permanent injunction to stop the state from denying access to antiviral medication.
7. The state has approved the drug in 413 of the 14,400 Coloradans with hepatitis C. For the 413, the treatment cost was $35.8 million, but Medicaid did not disclose any rebate it receives from drug companies.
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