**UPDATE**: If you or a family member has been diagnosed with Hep C while on Medicaid, you could be entitled to new drug treatments following the settlement in this case. Click here to read the notice.

On February 15, 2018, the ACLU of Kansas filed a class-action lawsuit on behalf of two individuals and all other similarly situated individuals against officials from the Kansas Department of Health and Environment and the Kansas Division of Health Care Finance. The suit challenged the policy of the Kansas Medicaid program, Kancare, as arbitrarily and irresponsibly restricting treatment for the Hepatitis C virus (HCV) to only the sickest patients. The policy thereby denied medically necessary treatment for many patients who still met the FDA's standards for coverage and violated conditions of Title XIX of the Social Security Act and the Medicaid Act. 

In the case, plaintiffs Jamie Harper and Jessica Owens, both Medicaid enrollees, were diagnosed with HCV and prescribed direct-acting antiviral drugs (DAAs). Both plaintiffs attempted to fill their prescriptions through their Medicaid coverage, and KanCare denied both of their requests because they were not "sick enough." 

The Hepatitis C virus is a life-threatening, communicable, blood-borne viral disease of the liver and can lead to chronic infection, chronic liver disease, cirrhosis, liver cancer, and death. Even before more advanced stages of the disease, HCV can cause heart attacks, fatigue, joint pain, depression, sore muscles, arthritis, and jaundice. 

Treatment with DAAs effectively cures HCV in more than 90% of individuals treated with the medication, and treatment guidelines adopted by American Association for the Study of Liver Diseases and the Infectious Diseases Society of America currently provide that DAAs should not be reserved for only individuals with more severe liver damage. Rather, the national standard of care with DAAs is consistent for all patients with chronic HCV infection as there are no equally effective alternative medications or medical interventions for HCV. 

Under the Medicaid program, DAAs meet the standard for coverage, and the Medicaid Act requires coverage of the medicine when it is for a medically accepted indication. The Harper v. Andersen case charges that the Kansas Medicaid coverage criteria for HCV violates federal law in that its standards for providing coverage of DAAs are more restrictive than the national standards and is also inconsistent with accepted medical practice, which provides that clinicians should treat HCV-infected patients early in the course of their infection before the development of severe liver disease or complications. These and other aspects of the defendants' coverage criteria needlessly exposed patients excluded from treatment to more severe progression of HCV and also increased the likelihood that members of the insured's households and the public would be exposed to and contract HCV. 

Kansas agreed to a settlement in the lawsuit in July, following mediation. 

 

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