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Post date: April 26 2016

A.G. Schneiderman Announces Major Agreement With Seven Insurers To Expand Coverage Of Chronic Hepatitis C Treatment For Nearly All Commercial Health Insurance Plans Across New York State

Insurers In New York Will No Longer Restrict Treatment For Hepatitis C Based On Disease Severity

NEW YORK- Attorney General Eric T. Schneiderman today announced a major agreement with seven health insurance companies to revise their coverage policies for chronic Hepatitis C treatment: Affinity Health Plan, Empire BlueCross BlueShield, Excellus Health Plan, HealthNow, Independent Health, United Healthcare/Oxford, and MVP Health Plan.  As a result of these agreements, nearly all commercial health insurance plans in New York State will cover treatment for chronic Hepatitis C without requiring members to develop advanced disease, such as liver scarring, and will not deny coverage because the member uses alcohol or drugs, or because the authorizing physician is not a specialist.

“New Yorkers diagnosed with Hepatitis C deserve to be treated, and these agreements will vastly improve access to the medications needed to cure their disease,” said Attorney General Schneiderman. “Hepatitis C is a potentially life-threatening disease and thousands of New Yorkers are diagnosed each year. My office will do everything possible to ensure treatment for Hepatitis C is available, so that patients can be cured and we can minimize the spread of the disease to others.”

Chronic Hepatitis C infection can cause liver failure, liver cancer, brain damage, and kidney failure – and, if left untreated, can result in cirrhosis and be fatal.  Chronic liver disease/cirrhosis is the twelfth leading cause of the death in the United States Approximately 3.5 million Americans suffer from a chronic hepatitis C virus infection, and it is estimated that 25,000 individuals become infected with hepatitis C each year.

Prior to the agreement, five of the seven insurers limited chronic hepatitis C coverage to members with advanced liver scarring or other complications.  Following these agreements, each of those insurers will eliminate restrictions requiring members to have advanced disease – such as advanced liver scarring – before their treatment will be considered “medically necessary” and covered by the plan. Additionally, prior to the agreement, four of the insurers denied coverage of treatment based on the members’ use of alcohol or other drugs, and three of the insurers only permitted specialists to authorize treatment.  These insurers have now agreed to not deny coverage based on members’ alcohol or drug use and to permit appropriately trained providers to authorize treatment.

By removing these three restrictive criteria, the insurers’ Hepatitis C coverage policies will more closely reflect evidence-based guidelines for treatment of chronic Hepatitis C infection.

The seven health plans must fully implement the revised criteria within 45 days of the agreement and will send notices to members who were denied coverage who may now be eligible for treatment. The investigation of this matter was conducted by Assistant Attorneys General Elizabeth Chesler and Adrienne Lawston, with assistance from Volunteer Attorneys General Matthew Reisman and Samuel Canales, of the Health Care Bureau, which is led by Bureau Chief Lisa Landau.  The Health Care Bureau is a part of the Social Justice Division, led by Executive Deputy Attorney General for Social Justice Alvin Bragg.

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