Medicaid Review Board lifts liver damage restriction on cures for hepatitis C

REGION – At its meeting on Oct. 24, Vermont Medicaid’s Drug Utilization Review Board (DURB) voted to lift the liver damage restriction that currently prevents many Vermont Medicaid patients with hepatitis C from accessing life-saving treatment. Because of this change many more Vermonters on Medicaid who have the life-threatening disease will gain access to curative treatment. Vermont Legal Aid’s Office of the Health Care Advocate and a coalition of organizations have been advocating for this change since 2015. The coalition sent a letter to the DURB earlier this month asking the Board to remove all remaining restrictions on hepatitis C medications.

On Tuesday, the DURB voted to stop requiring people to wait until they have significant liver damage to be treated. Since February, Vermont Medicaid has required a fibrosis score of F2 (moderate liver damage) or higher to access treatment. Prior to February Medicaid required a fibrosis score of F3 (severe liver damage) or F4 (cirrhosis) to access treatment. Patients will still need to see a specialist in order to get treatment.

The Medicaid Review Board, with the support of a coalition of advocacy groups, lifted the liver damage restrictions on patients’ ability to seek cures for hepatitis C. Stock photo.

“We are very pleased that the DURB voted to lift the liver damage restriction on hepatitis C treatment, as is required by federal Medicaid law. Treatment of every patient with hepatitis C is the standard of care. There is no medical justification for denying treatment because the patient’s liver isn’t damaged enough,” said Mike Fisher, Vermont’s chief Health Care Advocate. “Curing people with hepatitis C will have immediate and long-term benefits for individual Vermonters and for our communities. The HCA and the coalition will continue to advocate for Medicaid to allow treatment of hepatitis C by primary care providers.”

The coalition includes the ACLU of Vermont, Vermont CARES, the Prisoners’ Rights Office, AIDS Project of Southern Vermont, the HIV/HCV Resource Center, the Vermont People With AIDS Coalition, and Howard Center Safe Recovery. The Vermont Medical Society also sent a letter supporting the coalition’s request to remove Medicaid’s treatment criteria.

The Office of the Health Care Advocate (HCA) helps Vermont consumers with a broad range of problems and questions related to health care services and health insurance. The HCA acts as a voice and advocate for consumers in health care policy matters before the Vermont legislature and government agencies that oversee insurance and health care programs. The Office of the Health Care Advocate is a project of Vermont Legal Aid.

Vermont Legal Aid (VLA) is a non-profit law firm that provides legal advice and services to individuals and families throughout Vermont who are facing a civil legal problem that threatens their rights, shelter, job, health or well being. VLA began serving clients in 1968.

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