Texas Medicaid enrollees have filed a lawsuit against the state's health and human services commission, claiming the agency rations hepatitis C treatments to save money.
The state agency denies hepatitis C prescription coverage to patients unless they can prove they have severe liver damage. The lawsuit, which was filed Aug. 13 and is seeking class-action status, alleged these restrictions limit access to drugs that have cure rates near 100 percent for all patients, regardless of infection severity.
The lawsuit also argued that patients should not have to wait until they develop cirrhosis of the liver or other advanced liver diseases before gaining coverage eligibility. It also noted the agency's restrictions are contradictory to guidelines set by the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America.
"At the end of the day, Medicaid coverage is supposed to be governed by medical reasons, not fiscal concerns, especially in the circumstances here where there is no other equally effective treatment available," Kevin Costello, a lawyer representing the enrollees, said in an Aug. 13 statement. "We have strong reason to believe that HHSC's policy is motivated by short-sighted and fundamentally unsound budget fears."
Texas, which leads the country in liver cancer deaths according to the Texas Medical Association, is one of only three states that requires Medicaid beneficiaries to have severe liver disease before they are eligible for treatment coverage.