Some public health advocates say Iowa’s Medicaid program is illegally denying treatment for certain hepatitis c patients. With drugs that can cure 98 percent of patients, care for the potentially deadly disease is incredibly effective, but also incredibly expensive.
In recent years, many states across the country have limited hepatitis c treatment to only patients with late-stage liver disease, partly due to the high cost of treatment. Other restrictions are in place to withhold care from patients who use illicit drugs, including marijuana, and to limit the kinds of specialists who can prescribe the life-saving pills.
Iowa's Medicaid program implements all three of these limitations, a practice some physicians, researchers and advocates say is unlawful.
"The restrictions we have in Iowa are illegal," said Dr. Michael Voigt, a clinical professor at the University of Iowa who specializes in liver diseases and transplants.
Courts have struck down similar restrictions in multiple states, after the federal government released guidance in 2015 urging states to ensure patients have access to the drugs. The disease disproportionately impacts low income people, those who use drugs, and those who are imprisoned.
Drugs to treat the viral liver infection are prohibitively expensive in the United States, and can cost up to $94,000, although prices have gone down considerably due to competition and the approval of generics.
In the meantime, transmission of the potentially deadly disease is increasing in Iowa, particularly among people under the age of 40. Physicians say denying treatment to early-stage patients is leading to more deaths and more transmissions.
Critics say these limitations are in place solely as a cost-saving measure, including Des Moines-based liver doctor Don Hillebrand. He oversees UnityPoint Health's Center for Liver Disease. At a public health conference hosted by the Iowa Harm Reduction Coalition, he confronted the state's Medicaid Director Michael Randol about the approach.
“I think, and it’d be interesting to hear Mr. Randol, I think it’s all about money. You know?" he said. "It’s all about money!”
Randol disputed that, saying while the exorbitant cost of the drug is a factor, it is not the only factor in deciding which patients deserve which treatments.
“I don’t wake up every morning thinking about the money. I think about 676,000 Iowans that I have to provide services for," Randol said. “I want to say, I’m not trying to diminish what we’re talking about here today. But literally I have to look at 676,000 Iowans and we have to have a sustainable program three, five, seven years from now.”
Randol is requesting funds from the legislature to expand treatment to patients with less severe cirrhosis, in effect treating more patients earlier. The proposal is set to go into effect January 1, 2019, pending legislative approval. Randol says his staff is currently considering whether Iowa Code would permit potential changes to the other two restrictions, limiting access to drug users and limiting prescribing by doctors.