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AG’s office settles with health insurers on access to chronic Hepatitis C treatment

The three main health insurers in the Western New York market have agreed to change their policies for covering chronic Hepatitis C treatment following a settlement with the state Attorney General’s Office.

The insurers – HealthNow New York, the parent of BlueCross BlueShield of Western New York; Independent Health; and Excellus BlueCross BlueShield, the parent of Univera Healthcare – are among seven that reached a deal with Attorney General Eric Schneiderman. His office said Tuesday that New Yorkers with Hepatitis C now will have improved access to the medication needed to fight their disease.

Chronic Hepatitis C infection can cause liver damage, liver failure, liver cancer and it is the leading cause of cirrhosis. About 3.5 million Americans have a chronic hepatitis C virus infection, and 29,000 people became infected in 2013, according to the U.S. Centers for Disease Control and Prevention. Today, most patients are infected by sharing needles, syringes or other items used to inject drugs.

Gilead makes two drugs to treat Hepatitis C, Harvoni and Sovaldi. Sovaldi, approved in late 2013, costs $84,000 for a 12-week course, or $1,000 per pill, and the local insurance companies have spent tens of millions of dollars covering the drug.

Prior to the agreement, a number of the insurers restricted access to the medications by requiring members to develop advanced disease, such as liver scarring; denied coverage if the member used alcohol or drugs; or required only permitted specialists to authorize treatment. Locally, HealthNow required the development of advanced disease and the authorization of a specialist, Excellus required the development of advanced disease and denied coverage in cases of alcohol or drug use and Independent Health imposed all three restrictions, according to the Attorney General’s Office.

“By removing these three restrictive criteria, the insurers’ Hepatitis C coverage policies will more closely reflect evidence-based guidelines for treatment of chronic Hepatitis C infection,” the office said in a statement.

The seven insurers must made the changes to their policies within 45 days and notify any patients whose coverage previously was rejected that they now may be eligible for treatment.

The local insurers issued statements Tuesday saying they regularly review and modify their policies to ensure they meet the evolving guidelines for Hepatitis C treatment.