WASHINGTON—The National Health Law Program (NHeLP) sent a letter to Senators Ron Wyden and Chuck Grassley supporting the Senate Finance Committee’s investigation into high prices for hepatitis C prescription drugs and barriers to access for Medicaid beneficiaries. The committee requested public comments in January 2016 on its investigation into biopharmaceutical company Gilead and Sovaldi and Harvoni, Gilead’s breakthrough hepatitis C treatments.
“As we have seen with HIV treatments, drug company profiteering and high costs prevent people from getting the care they need,” said Wayne Turner, NHeLP staff attorney who led the successful 2014 HIV anti-discrimination complaint against four insurance companies. “When people with chronic diseases like hepatitis C are unable to afford treatments due to state restrictions or discriminating company policies, federal action is necessary.”
In 2014, The AIDS Institute and NHeLP filed a complaint with the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) charging four Florida health plans with unlawful discrimination against people living with HIV and AIDS by placing all HIV medications, including generics, on the highest cost sharing tier, thus requiring enrollees to pay as much as 50 percent co-insurance for every HIV drug. In the complaint, the groups contend that such practices discourage people with HIV/AIDS from enrolling in the plans and violate the Affordable Care Act’s (ACA) non-discrimination provisions. The ACA bans plans from discriminating against individuals based upon disability and prohibits them from discouraging enrollment by people with significant health needs.
“Since the passage of the Affordable Care Act, we have monitored Medicaid enrollment efforts across the country to ensure states are making every effort to help residents obtain adequate health insurance coverage, which should include affordable prescription drugs,” said Jane Perkins, NHeLP legal director. “Restrictions on breakthrough treatments are blatantly illegal and violate federal Medicaid requirements and the ACA’s non-discrimination provisions.”
“Low-income individuals so often are the most in need of breakthrough treatments and are the least likely to afford them,” said Abbi Coursolle, NHeLP staff attorney. “It is inherently unfair for Medicaid beneficiaries to be both denied treatments simply because they are expensive and unable to afford the two most widely used medications because of the company mark-up.”