Leaders in Massachusetts recently took steps to ensure that all members of MassHealth, the state’s health insurance program for low- and moderate-income residents, have access to medications to treat hepatitis C. Following months of negotiations, MassHealth and Gilead Sciences announced a rebate program that considerably reduces the price of Harvoni, the company’s hepatitis C drug, and two other medications.
The program goes into effect Aug. 1.
Harvoni will be the exclusive therapy for the vast majority (about 80%) of MassHealth members infected with the hepatitis C virus (HCV). MassHealth also negotiated rebates for two other therapies: Gilead’s drug Sovaldi, and Bristol-Meyers Squibb’s drug Daklinza, which together are indicated for about 20% of patients with hepatitis C.
In Massachusetts, Medicaid and the Children’s Health Insurance Program (CHIP) are combined into one program called MassHealth. MassHealth members are able to visit doctors, and have access to prescription drugs, hospital stays, and other important services at reduced or no cost.
“MassHealth’s new rebate program improves care for thousands of its members with Hepatitis C and represents a strong economic value to the Commonwealth,” said Gov. Charlie Baker in a news release. “I appreciate that both parties were able to come to an agreement that provides those infected with Hepatitis C access to a life-changing therapy.”
“Our goal is to ensure a sustainable, cost-effective approach to covering MassHealth members who need treatment for Hepatitis C infection,” said Marylou Sudders, secretary of the Executive Office of Health and Human Services.
Most MassHealth members, cared for under a fee-for-service program, already had access to Harvoni and Sovaldi therapies. However, more than 500,000 MassHealth members faced restrictions.
Since Sovaldi came to market as the first hepatitis C drug in Dec. 2013, and up through January 2016, MassHealth assisted 2,830 members covered by the Primary Care Clinician (PCC) plan. Its contracted Managed Care Organizations (MCO) covered another 1,600 people.
The cost for the hepatitis C medications for those members totaled around $318 million, largely due to the high price of therapy — which runs up to $94,500 for a full course of treatment before discounts — and did not include other hepatitis C-related treatment services covered by MassHealth or its MCOs, including outpatient treatment.
“This drug saves lives, but its very high price has kept a cure out of the hands of people who need it,” state Attorney General Maura Healey said. “This rebate agreement will expand access to much-needed medication for people suffering from Hepatitis C, and it will save millions in taxpayer dollars. We are working hard with Gilead to improve the affordability of Sovaldi and Harvoni, and we are pleased the company has shown a commitment to increasing access to these drugs.”