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NC Medicaid Program Removes Hepatitis C Treatment Restrictions

Alex Olgin

Starting today, the North Carolina Medicaid program will pay for medicines to treat hepatitis C for patients no matter how sick they are. In the past, the state wouldn’t pay for the expensive drugs unless the patient had stage two liver damage.  

Thirty-five-year-old Ginger Parker doesn’t know how long she’s had hepatitis C. She used heroin for nine years, so she’s pretty sure she knows how she got the viral infection that attacks the liver.   

“We all shared needles,” she said. “I don’t know exactly how many. It was just the thing that you did. ”

She is now in recovery in west Charlotte. A few months ago she went to the doctor in hopes of getting the medicine that can cure the disease in most people, but she was met with devastating news. The North Carolina Medicaid program wouldn’t pay for the treatment until she had a certain amount of liver damage.

“For the first time in my life I’m trying to get treatment, be healthy, really be a functioning member of society,” Parker said. “And I have to wait till I’m sick before I can get treatment.”

But the state has since changed that rule and it will start paying for the medicines starting today.

“It was like a miracle,” she said “[I was} so happy”

The North Carolina Department of Health and Human Services wouldn’t say how much the expanded program will cost, but it will likely be a lot. Last year the state spent $72.6 million treating 1,056 Medicaid patients with hepatitis C.  The department projects an initial spike in people seeking the medicines, but expects that to stabilize shortly after.

That matches with what Matt Salo, with the National Association for Medicaid Directors, has seen in other states. 

“You are not getting 100 percent of those people showing up. And so the fear about that giant explosion of cost has come down,” Salo said. “That has allowed states to say we can open up the coverage.”

Hepatitis C attacks the liver over time. It first starts with scarring called fibrosis. Until now, a patient had to have stage two liver scarring before the state Medicaid program would pay for treatment. But Dr. Michael Fried with the University of North Carolina Chapel Hill has been trying to get his patients medicines earlier.

“We are actually trying to treat people before they get advanced degrees of fibrosis, because that leads to cirrhosis and risks for liver cancer and all the complications related to chronic liver disease,” says Fried. 

He said he has hundreds of patients that will now be able to get these medications. Fried has received research funding and serves as a consultant to some of the drug companies that make the hepatitis C drugs. The state’s largest insurer, Blue Cross Blue Shield of North Carolina, also removed treatment restrictions last year.