N.Y. Health Plans Expand Coverage for Hepatitis C Treatment

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By Gerald B. Silverman

April 26 — Seven insurance companies will expand their coverage for the treatment of hepatitis C in New York, under agreements announced April 26 by Attorney General Eric T. Schneiderman (D).

The health plans agreed to remove any limits on coverage that required patients to be in advanced stages of the disease, such as those with liver scarring. They also agreed not to deny coverage for patients with drug or alcohol use or for patients whose physicians who are not specialists.

The agreements mean health plans will no longer limit coverage of expensive drugs and treatment to those in advanced stages of the disease.

The health plans are: Affinity Health Plan, Empire BlueCross BlueShield, Excellus Health Plan, HealthNow, Independent Health, United Healthcare/Oxford and MVP Health Plan.

Schneiderman said five of the seven plans previously limited chronic hepatitis C coverage to members with advanced liver scarring or other complications, contending that treatment was not medically necessary otherwise.

In addition, he said four of the health plans denied coverage based on the member's use of alcohol or other drugs, while three plans only allowed specialists to authorize treatment.

The health plans have 45 days to implement the changes.

Drug Affordability

Paul Macielak, president and chief executive officer of the New York Health Plan Association, said newer drugs being used to treat hepatitis C are “exorbitantly expensive.”

“Their high prices continue to be a major factor driving up the cost of pharmacy benefits and increasing the overall cost of health insurance to hundreds of thousands of individual New Yorkers and small businesses,” he said in a statement. “New York should focus on affordability by taking a more aggressive position on the excessive pricing of these Hepatitis C drugs.”

He said coverage policies change as clinical standards evolve.

Sally Kweskin, a spokeswoman for Empire BlueCross BlueShield, told Bloomberg BNA in an e-mail that Empire began “proactively modifying its criteria relating to Hepatitis C treatments” in January. “Empire voluntarily entered into this agreement with the Attorney General to establish uniform criteria in the evolving area of treatment for Hepatitis C,” she said.

Jim Redmond, a spokesman for Excellus BlueCross BlueShield, said the plan was changing its policy “in a manner that reflects consistent and emerging treatment guidelines for chronic hepatitis C.”

To contact the reporter on this story: Gerald B. Silverman in Albany, N.Y., at gsilverman@bna.com

To contact the editor responsible for this story: Janey Cohen at jcohen@bna.com

For More Information

The attorney general's announcement is at http://src.bna.com/eqc.