MassHealth Implements New Drug Rebate Program, Expands Access to Hep C Treatment

BOSTON — Today the Baker-Polito Administration announced it has taken affirmative steps to ensure that all MassHealth members have unrestricted access to Hepatitis C medications when medically necessary. After months of negotiations, MassHealth, the state’s Medicaid program, and Gilead Sciences, Inc., agreed to a new rebate that significantly lowers the cost of their Hepatitis C drug. This new program goes into effect August 1st.

Gilead’s Hepatitis C drug, Harvoni, will be the exclusive therapy for the vast majority (approximately 80 percent) of MassHealth members infected with the Hepatitis C virus. MassHealth also negotiated rebates for two other therapies: Gilead’s drug, Sovaldi, and Bristol-Meyers Squibb’s drug, Daklinza, which together are indicated for approximately 20 percent of Hepatitis C patients.

“MassHealth’s new rebate program improves care for thousands of its members with Hepatitis C and represents a strong economic value to the Commonwealth,” said Governor Charlie Baker. “I appreciate that both parties were able to come to an agreement that provides those infected with Hepatitis C access to a life-changing therapy.”

“Our goal is to ensure a sustainable, cost-effective approach to covering MassHealth members who need treatment for Hepatitis C infection,” said Secretary of the Executive Office of Health and Human Services, Marylou Sudders. “The MassHealth negotiating team led by Assistant Secretary Dan Tsai was committed to extending access at no net increase to the Commonwealth. We will continue to push drug companies to give us the very best prices on new treatments as they come on the market.”

Between December 2013 (when the Hepatitis C drug Sovaldi came to market) and January 2016, MassHealth has covered Hepatitis C drugs for approximately 2,830 members in the state-administered Primary Care Clinician (PCC) plan and its contracted Managed Care Organizations (MCO) have covered 1,600. The cost of the Hepatitis C drugs for those members was approximately $318 million and did not include other Hepatitis C-related treatment services covered by MassHealth or its MCOs, including outpatient treatment.

“This drug saves lives, but its very high price has kept a cure out of the hands of people who need it,” said Attorney General Maura Healey. “This rebate agreement will expand access to much-needed medication for people suffering from Hepatitis C, and it will save millions in taxpayer dollars. We are working hard with Gilead to improve the affordability of Sovaldi and Harvoni, and we are pleased the company has shown a commitment to increasing access to these drugs.”

MassHealth, which has more than 1.85 million members, leveraged its purchasing power by negotiating on behalf of members in the state-administered PCC program, its fee-for-service program, and the six Managed Care Organizations (MCOs) that cover MassHealth members.

The federal Centers for Disease Control and Prevention has estimated that approximately 1 to 1.5 percent of the general population are infected with Hepatitis C, many of whom may not be aware that they are infected.

About MassHealth

MassHealth provides health care benefits to more than 1.85 million low- and moderate-income Massachusetts children, families, seniors, and people with disabilities. MassHealth offers these benefits directly, or by paying part of other health-insurance premiums through Boston Medical Center’s HealthNet Plan; CeltiCare, Fallon Health Plan; Health New England; Neighborhood Health Plan; Tufts Health Plan; or the state-administered Primary Care Clinician (PCC) Plan.

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