July 6, 2016
Contact: Matt Salo
NAMD Calls on Congress to Act on Hepatitis C Drug Costs and Access
Changes Needed to Allow States to Effectively & Efficiently Manage the Medicaid Program
Washington, DC – The Medicaid program is the nation’s largest health insurer, providing coverage to more than 72 million Americans, but it is also the nation’s health care safety net, providing coverage for the sickest, frailest and most complex and costly patients in the country. State Medicaid Directors must carry out this critical mission while being responsible stewards of the taxpayer dollar and ensuring the sustainability of program in both the short and long term.
No issue in recent memory has challenged this mission like the introduction of curative therapies for Hepatitis C, a pervasive public health threat which affects more than 3 million Americans, approximately 1 million of whom are Medicaid eligible. The issue is complex because while the innovations brought about by the pharmaceutical industry have brought us closer to a future where we can effectively eradicate this disease, the high price tag of treatment is clearly unsustainable and is threatening the careful balance of Medicaid’s mission to serve the broader group of low-income, vulnerable populations.
Medicaid programs have decades of experience providing care to medically complex patients, but Hepatitis C is the first real case where a very high per patient cost has been combined with a very large patient population needing treatment. Medicaid Directors must make difficult choices every day to ensure that the maximum good can be delivered to the system, within tight budget parameters.
As CMS Administrator Slavitt noted in a June 30 statement, several states recently have modified their coverage policies. Like Administrator Slavitt, however, we remain concerned that the cost of Hepatitis C medications remains high, even with the so-called discounts that state are able to negotiate.
To be clear, any arrangements negotiated by states and manufacturers do not absolve Congress of addressing the real problem of irrational pricing for drug treatments. As we have stated on multiple occasions, beginning in October 2014, and more recently in March 2016, states have never had the financial capacity to cover the full costs of these treatments, nor do we have the clear statutory authority to effectively and efficiently administer the program.
If Congress cannot enact policies that either reduce the cost of these curative treatments, or reduce state Medicaid program’s financial exposure to them, then Congress must make significant changes to the Medicaid Drug Rebate Program to enable states to effectively utilize market forces to do so on their own.
Medicaid Directors stand with the public health community and the patients who have suffered from this pervasive disease for far too long, in their desire to effectively eradicate this condition, but we will need those communities to stand with us to ensure that we can do so in an affordable way that doesn’t jeopardize care for the rest of the 72 million Medicaid beneficiaries we serve.
# # # #
The National Association of Medicaid Directors (NAMD) is a bipartisan, nonprofit, professional organization representing leaders of state Medicaid agencies across the country. NAMD members drive major innovations in health care while overseeing Medicaid, one of the nation’s most vital health care safety net programs, which covers more than 72 million Americans. NAMD serves as the voice for state Medicaid directors in national policy discussions, supports state-driven policies and practices that strengthen the efficiency and effectiveness of Medicaid and actively monitors emerging issues in Medicaid and health care policy. Learn more at www.medicaiddirectors.org and follow NAMD on Twitter @statemedicaid.