Restricted Access: State Medicaid Coverage of Sofosbuvir Hepatitis C Treatment

Chronic hepatitis C (HCV) infection can persist for decades without symptoms. Many Americans are unaware of their infection status and are not receiving necessary care and treatment. This places them at greater risk for severe, even fatal, complications from the disease and increases the likelihood that they will transmit the virus to others. In late 2013, the Food and Drug Administration approved a direct acting antiviral drug called sofosbuvir to treat chronic HCV infection. Sofosbuvir is a highly effective, but very expensive, curative treatment for HCV. Unfortunately, the high price of sofosbuvir has led payers, including Medicaid, to restrict patient access. Looking at the sheer cost of the HCV crisis facing the United States, particularly among minority communities, it is a critical time to invest in prevention, screening, and treatment. These pharmaceutical treatments have the potential to cure HCV, eliminate the virus, and mitigate future health care expenses. This article argues that restricting access to this pharmaceutical treatment may be a discriminatory practice under both Medicaid law and the Affordable Care Act (ACA). In addition to potential legal challenges, there are strong economic and public health imperatives to removing barriers to HCV treatment.