{"id":935,"date":"2016-06-07T18:54:54","date_gmt":"2016-06-07T18:54:54","guid":{"rendered":"http:declasi.org\/news-and-stories\/uncategorized\/facing-lawsuit-de-medicaid-removes-restriction-life-saving-drug\/"},"modified":"2026-02-09T10:29:26","modified_gmt":"2026-02-09T15:29:26","slug":"facing-lawsuit-de-medicaid-removes-restriction-life-saving-drug","status":"publish","type":"post","link":"https:\/\/www.declasi.org\/es\/news-and-stories\/disability\/facing-lawsuit-de-medicaid-removes-restriction-life-saving-drug\/","title":{"rendered":"Facing Lawsuit, DE Medicaid Removes Restriction on Life Saving Drug"},"content":{"rendered":"<p>After weeks of negotiation arising from a formal threat of\u00a0litigation, officials at the Delaware Department of Health and Human Services and its Division of\u00a0Medicaid and Medical Assistance (DMMA) have changed their policy on rationing coverage of\u00a0life-saving drugs to cure Hepatitis C virus (HCV). On March 28, 2016, attorneys from Community\u00a0Legal Aid Society, Inc. of Delaware, in conjunction with Tycko &amp; Zavareei LLP, and the Center\u00a0for Health Law and Policy Innovation at Harvard Law School sent a formal demand letter to\u00a0Delaware officials on behalf of their client, Valerie Green, a Delaware Medicaid recipient. The\u00a0demand letter notified DMMA officials that unless it immediately agreed to remove categorical\u00a0coverage exclusions of HCV cures from its Medicaid policy, Delaware would face a federal class\u00a0action lawsuit. On Friday, June 3, 2016, DMMA officials issued a policy revoking these\u00a0categorical exclusions, effective immediately.<\/p>\n<p>The state\u2019s concession represents a substantial win for Delaware\u2019s Medicaid population.\u00a0\u201cDMMA\u2019s new approach is a sea-change in policy that will directly improve the lives of many of\u00a0our clients\u2014some of Delaware\u2019s most vulnerable citizens. To the extent that DMMA is now\u00a0focusing on the individual health circumstances of each person whose doctor has prescribed\u00a0these medications, Delaware\u2019s approach will now be consistent with the law and with many\u00a0other states around the country,\u201d said Laura Waterland of CLASI. Valerie Green adds \u201cthe\u00a0weight of the world has been lifted off my shoulders. Now I\u2019m excited about my future. I know\u00a0that everyone else who\u2019s in my position feels the same way. It\u2019s like getting a new lease on\u00a0life.\u201d<\/p>\n<p>HCV is a communicable disease that causes chronic inflammation throughout the body and can\u00a0lead to serious liver damage and infections, liver cancer, and death. At least 20,000 people in\u00a0the United States die each year due to liver disease caused by HCV, making it the most deadly\u00a0communicable disease in the United States. Even before the advanced state of the disease,\u00a0individuals with HCV can suffer from diabetes, lymphoma, fatigue, joint pain, depression,\u00a0myalgias, arthritis and jaundice.<\/p>\n<p>In 2011, the United States Food and Drug Administration (FDA) began approving Direct Acting\u00a0Antiviral (DAAs) drugs to treat HCV, and in 2014 the FDA approved ledipasvir-sofosbuvir to\u00a0effectively cure the disease. Treatment guidelines approved by the American Association for\u00a0the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America confirm that\u00a0DAAs should be available for \u201call patients with chronic HCV infection, except those with short\u00a0life expectancies that cannot be remediated by treating HCV, by transplantation, or by other<br \/>\ndirected therapy.\u201d See <a href=\"http:\/\/hcvguidelines.org\/full-report\/when-and-whom-initiate-hcvtherapy\" target=\"_blank\">http:\/\/hcvguidelines.org\/full-report\/when-and-whom-initiate-hcvtherapy<\/a>\u00a0(last visited 6\/6\/16). For its part, the federal Centers for Medicare and Medicaid\u00a0Services issued guidance in November 2015 warning states that exclusions and limitations on\u00a0public insurance coverage of DAAs may violate federal law.<\/p>\n<p>Prior to last week\u2019s change, DMMA restricted Medicaid coverage for the HCV cure only to those\u00a0whose disease had progressed to the point of significant liver damage or cirrhosis. This was\u00a0flatly inconsistent with the clinical standard of care noted above.<\/p>\n<p>Anna Haac of the law firm Tycko &amp; Zavareei LLP says, \u201cit is unimaginable that an insurance\u00a0provider would tell someone with cancer \u2018We need to wait until you get really sick before we\u00a0treat you.\u2019 But that\u2019s what patients in Delaware with HCV were being told, and what patients in\u00a0other states are still being told. It\u2019s unconscionable. Lawyers and advocates have been waiting\u00a0for Delaware to live up to its promise to Medicaid patients. It is unfortunate that it took the\u00a0threat of a federal class action suit, but ultimately I\u2019m glad to see that Medicaid enrollees will\u00a0no longer be barred from needed medicines.\u201d<\/p>\n<p>By making this policy change voluntarily, Delaware joins a rapidly growing list of states that\u00a0have come into compliance with federal medical necessity requirements for Medicaid. On May\u00a017, 2016, Pennsylvania\u2019s Pharmacy &amp; Therapeutics Committee voted to recommend the\u00a0removal of all disease severity restrictions for Hepatitis C treatment from the state\u2019s Medicaid\u00a0policy. Florida Medicaid took a similar step last week. And on May 27, 2016, a federal judge\u00a0ordered the state of Washington to strike its Medicaid policy imposing similar coverage\u00a0exclusions. &#8220;Delaware has taken an important first step here,\u201d said Kevin Costello, Director of\u00a0Litigation at the Center for Health Law and Policy Innovation at Harvard Law School. \u201cBut\u00a0enforcement remains key to make sure that the policy is made meaningful. This change is not\u00a0only the right thing to do from a public health and legal point of view, but it also been proven\u00a0that this policy will be cost-effective for the state in the long run. And it goes without saying\u00a0that the real potential of this cure is the eradication of HCV altogether, a goal that is furthered\u00a0by early treatment of Medicaid beneficiaries that makes, in their case, further transmission of\u00a0the virus impossible.\u201d<\/p>","protected":false},"excerpt":{"rendered":"<p>After weeks of negotiation arising from a formal threat of\u00a0litigation, officials at the Delaware Department of Health and Human Services and its Division of\u00a0Medicaid and Medical Assistance (DMMA) have changed their policy on rationing coverage of\u00a0life-saving drugs to cure Hepatitis C virus (HCV). On March 28, 2016, attorneys from Community\u00a0Legal Aid Society, Inc. of Delaware, [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[20,23,13,28],"tags":[],"class_list":["post-935","post","type-post","status-publish","format-standard","hentry","category-clasi-updates","category-disability","category-press-releases","category-public-benefits"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Facing Lawsuit, DE Medicaid Removes Restriction on Life Saving Drug - Community Legal Aid Society, Inc.<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.declasi.org\/es\/news-and-stories\/disability\/facing-lawsuit-de-medicaid-removes-restriction-life-saving-drug\/\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Facing Lawsuit, DE Medicaid Removes Restriction on Life Saving Drug - Community Legal Aid Society, Inc.\" \/>\n<meta property=\"og:description\" content=\"After weeks of negotiation arising from a formal threat of\u00a0litigation, officials at the Delaware Department of Health and Human Services and its Division of\u00a0Medicaid and Medical Assistance (DMMA) have changed their policy on rationing coverage of\u00a0life-saving drugs to cure Hepatitis C virus (HCV). 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