The lawsuit is being led by Robert Lee Cunningham, a Denver man represented by ACLU Colorado. Mr. Cunningham was denied the life-saving medication because under Medicaid policy, he “has not yet suffered measurable and potentially irreversible liver damage,” according to his lawsuit, the Denver Post reported.
The state’s Medicaid program only covers the 12-week, $40,000 prescription for people with hep C that has progressed to stage two liver scarring on a scale of zero to four. In comparison, private insurance companies cover the medication for anyone with the virus, regardless of its progression.
Following criticisms by the ACLU and Denver Health Medical Center regarding its policy and recommendations from the state drug review board, Colorado’s Medicaid program expanded coverage effective Sept. 1 to allow people in the second stage of liver scarring to receive the drug. Previously it required that patients reach stage three to be eligible for coverage.
In addition, the amended policy expanded coverage to women who planned to become pregnant within a year and lifted restrictions that excluded anyone who used alcohol or illegal drugs within the previous six months.
However, ACLU of Colorado says the expansion doesn’t go far enough. “We are challenging a policy that forces Coloradans who cannot afford private insurance to live with the serious negative health effects of hepatitis C and to wait for a cure, possibly for years, until they have suffered measurable and potentially irreversible liver damage,” said Mark Silverstein, legal director for ACLU Colorado, according to the report.
The lawsuit seeks a permanent injunction prohibiting the state from denying access to new antiviral medications. Medicaid officials did not provide the Denver Post with a comment on the case.
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