Medicaid enrollees sue Texas agency over access to hep C drugs

A group of Medicaid beneficiaries is suing a Texas health agency, claiming that it’s restricting coverage of hepatitis C medications — allowing only those with severe liver damage to access the life-saving medications. The cure rate for hepatitis C drugs like Sovaldi and Harvoni, of course, is almost 100%, so the plaintiffs are claiming that it’s unfair that they must wait until they have advanced liver disease or cirrhosis before being eligible for coverage.

“At the end of the day, Medicaid coverage is supposed to be governed by medical reasons, not fiscal concerns, especially in the circumstances where there is no other equally effective treatment available,” one Harvard law professor told STAT’s Ed Silverman. “We have strong reason to believe that HHSC’s policy is motivated by short-sighted and fundamentally unsound budget fears.”