A panel of legislators Friday reversed their recommendation of a lifetime ban on hepatitis C drugs for Medicaid patients who don’t comply with their treatment regimen.
Members of the Joint Committee on Home and Community Based Services and KanCare Oversight walked back on the recommendation they made in December after hearing from Mike Randol, who heads the Kansas Department of Health and Environment’s Division of Health Care Finance.
Randol acknowledged that the hepatitis C drugs are expensive but said KDHE has procedures in place to ensure that Kansans on Medicaid who abuse alcohol or intravenous drugs aren’t getting coverage for the medications.
“We do not believe it prudent to pay for those medications for those likely to either become re-infected or who are actively damaging their liver, regardless,” Randol said. “This is very common in other Medicaid programs as well.”
But Randol said a lifetime ban goes too far to withstand scrutiny from the federal Centers for Medicare and Medicaid Services, which provide more than half of Medicaid funding.
“We do not believe that CMS would approve policy for a lifetime ban of medical beneficiaries for hepatitis C medications,” Randol said.
The Republican-controlled committee voted 5-2 on party lines last month to recommend that KDHE impose the ban.
The partisan divide bubbled back to the surface Friday.
Rep. Jim Ward, a Democrat from Wichita, reiterated his claim that the lifetime ban amounted to a “death sentence” for Kansans who have hepatitis C.
Sen. Mary Pilcher-Cook, a Republican from Shawnee, objected to Ward’s statement, calling it “way over the top.”
Minutes later the committee voted to scrap the lifetime ban recommendation, over Pilcher-Cook’s objection.
Randol said KDHE bases its prior authorization procedures for the hepatitis C medications on guidelines from the American Association for the Study of Liver Disease and the Infectious Disease Society of America that steer the medications to those who need them most.
The committee has a new rule for those who want to testify about problems with the managed care organizations that now run Kansas Medicaid, or KanCare.
The committee’s chairman, Rep. Dan Hawkins, said Friday that in the future the committee will require all health care consumers or providers who dispute the way the KanCare companies handled a claim to submit the claim information to the committee at least one week before its next meeting.
Hawkins said the companies would then be asked to bring their information about the claim to the meeting, which would allow for a more substantive discussion like the one the committee had Friday with the companies and Lawrence Memorial Hospital.
“I can assure you somebody might say, ‘Dan’s trying to stifle claims,’ but that’s absolutely not the case,” Hawkins said. “Actually, I want this process to be very fair and very transparent, and I want everybody to be able to discuss things just like we did today in a fair manner.”
The KanCare oversight committee meets quarterly. Its next meeting is scheduled for April 26.
Andy Marso is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team. You can reach him on Twitter @andymarso