Members of the Washington’s Public Employees Benefits Board infected with hepatitis C will be able to receive expensive drugs that can cure the life-threatening disease, a judge ruled Wednesday.
A King County Superior Court judge has ordered the agency that oversees health insurance for Washington’s public employees to pay for expensive drugs to treat hepatitis C in all patients, not just those with the most severe illness.
Judge Suzanne R. Parisien granted a preliminary injunction Wednesday that requires the state Health Care Authority (HCA) to halt a policy that limited access to the drugs based on a patient’s fibrosis score, a measure of liver damage.
The order came in response to a lawsuit filed by two members of the state Public Employees Benefits Board, identified only as N.C. and L.J. But Parisien also granted a request to include about 277,000 PEBB members as a protected class in the matter. That number includes people enrolled in the Uniform Medical Plan, including about 4,000 diagnosed with hepatitis C.
At least 150 PEBB members had been turned down for care in recent years, lawyers said.
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The decision is only the most recent action in Washington to expand access to drugs that can halt life-threatening hepatitis C infection. Direct-acting antivirals such as Harvoni have posted cure rates of at least 90 percent. But the market cost is nearly $95,000 for a 12-week treatment.
The Health Care Authority was among many insurance providers that initially restricted access to the expensive drugs to the sickest patients, a stance originally supported by medical guidelines. That changed last year. Experts in liver treatment and infectious disease now agree that the drugs should be routinely used to treat all patients, including those with mild disease.
Similar actions in Washington targeted private insurersGroup Health Cooperative and BridgeSpan, a subsidiary of Regence Blue Shield. Those insurers both changed their policies. And a federal judge in May ordered HCA to cover drugs for Medicaid patients with hepatitis C.
The addition of PEBB members means even more patients will be covered, advocates said.
“The calls in Washington state have dropped off precipitously,” said Ele Hamburger, a lawyers with firm Sirianni, Youtz, Spoonemore and Hamburger, which filed the suit.
Still, some private insurers still ration the drugs. And Washington’s Department of Corrections, which provides treatment for nearly 18,000 inmates, bases treatment on severity of illness, a spokesman said.
“Anecdotally, we’ve seen those plans changing,” Hamburger said. “Anyone who’s not covering it clearly is an outlier.”