November

19, 2015

Jeff Myers
Chief Executive Officer
Medicaid Health Plans of America
SENT VIA EMAIL: jmyers@mhpa.org

Dear Mr. Myers,

As patient advocates, public health organizations, health care reform organizations, liver
disease specialists, researchers, and physicians we are shocked by your recent statements to
the media in response to the notice the Centers for Medicare & Medicaid Services (CMS) sent
to all 50 state Medicaid directors about access to hepatitis C treatments in Medicaid health
plans1.

Your defense of health plans prior authorization policies that bar people from medically
necessary treatment is based on stigma, not evidence, and you are perpetuating damaging and
dangerous myths about treating people with substance use disorders. Your recent statements
to the media defy the science of hepatitis C treatment, the science of addiction medicine, and
the federal laws outlined in the CMS notice2.

The professional guidance for treating hepatitis C, developed by experts from the American
Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of
America (IDSA)3, cites the abundant scientific literature about hepatitis C treatment and
recommends treatment for all patients with chronic hepatitis C, unless they have a short life
expectancy due to another condition.

On November 16, 2015, AASLD issued a statement4 that included the following: Over the past
two-plus years, the Food and Drug Administration has approved multiple new treatments for
hepatitis C virus (HCV) that offer nearly universal cure rates with minimal side effects. It is a
remarkable success story for medical science. Unfortunately, many insurers both private and
public are delaying access to new HCV treatments to patients until their disease has
progressed and the liver is further damaged. There is no medical evidence to justify that
position and much to justify treating all patients. [] Inaction is harmful to patients []
Failure to treat leads to other medical problems.


1
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/ByTopics/Benefits/Prescription-Drugs/Downloads/Rx-Releases/State-Releases/state-rel-172.pdf
2
http://www.modernhealthcare.com/article/20151106/NEWS/151109917,
http://www.bna.com/cms-enters-pricey-b57982063428/
3
http://www.hcvguidelines.org/full-report/when-and-whom-initiate-hcv-therapy
4
http://www.prnewswire.com/news-releases/leading-liver-doctors-hepatitis-c-patients-mustbe-treated-300179479.html

AASLD/IDSA guidance states that excluding people from hepatitis C therapy based on the
amount of alcohol they drink is not supported by data. While alcohol can worsen liver damage
in general, there is no evidence that alcohol use counteracts the efficacy of hepatitis C
treatment medications in curing the disease. In fact, curing hepatitis C in people who drink
heavily is imperative to mitigate liver damage.

The guidance also notes that [t]here is strong evidence from various settings in which persons
who inject drugs have demonstrated adherence to treatment and low rates of reinfection,
countering arguments that have been commonly used to limit access to this patient population
[] Conversely, there are no data to support the utility of pretreatment screening for illicit drug
or alcohol use in identifying a population more likely to successfully complete [hepatitis C]
therapy. These requirements should be abandoned, because they create barriers to treatment,
add unnecessary cost and effort, and potentially exclude populations that are likely to obtain
substantial benefit from therapy. Scale up of [hepatitis C] treatment in persons who inject drugs
is necessary to positively impact the [hepatitis C] epidemic in the United States and globally.

All people living with hepatitis C deserve access to effective, curative treatments, just as any
other patients deserve access to medically necessary and clinically appropriate care5. Given the
important role of Medicaid health plans in providing quality health care to low-income and
marginalized communities we would hope that the leaders of MPHA would promote the
necessity of basing treatment decisions on science, rather than stigma, and would encourage
MHPA members to both act ethically and legally by following the laws outlined in the CMS
notice.

We call on you to retract your recent statements and promote the science and laws relevant to
hepatitis C treatment among MPHA members immediately. Additionally, we request the
opportunity to meet with you at your earliest convenience to discuss these matters. Ryan Clary
at the National Viral Hepatitis Roundtable or a representative will be contacting you to schedule
a meeting. He may be reached at rclary@nvhr.org or (202) 407-2391.

PHYSICIAN & RESEARCHER SIGNATORIES
Frederick L. Altice, MD, MA
Brian R. Edlin, MD, FACP, FIDSA
Judith Feinberg, MD
Eyob Feyssa, MD, MPH, FACP
Dawn Fishbein, MD, MS
Ian Frank, MD
Donna Gilmore, MD
Robert Gish, MD, FAASLD
Robert Heimer, PhD
Jay Kostman, MD

5
http://nvhr.org/sites/default/files/.users/u27/NVHR%20Cure%20Fact%20Sheet_One%20Pager
.pdf

Andrew J. Muir, MD
David C. Perlman, MD
Russell Perry MD, FAAFP
Ponni V. Perumalswami, MD
Josiah D. "Jody" Rich, MD, MPH
Diana L. Sylvestre, MD
Lynn E. Taylor, MD
Stacey Trooskin, MD, PhD

ORGANIZATIONAL SIGNATORIES
ACT UP New York
AIDS Alabama
The AIDS Institute
AIDS Project Los Angeles
APLA Health & Wellness
Access Support Network, San Luis Obispo and Monterey Counties
American Association for the Study of Liver Diseases
Association of Asian Pacific Community Health Organizations
Berkeley Free Clinic
BOOM!Health
The CHOW Project
C.O.R.E. Medical Clinic
California Hepatitis Alliance
Caring Ambassadors Program, Inc.
Catholic Charities Care Coordination Services
Chicago Recovery Alliance
Cincinnati Exchange Project
Coalition on Positive Health Empowerment (COPE)
Community Access National Network (CANN)
Community Health Action of Staten Island
Directors of Health Promotion and Education
Drug Policy Alliance
End AIDS Now
Global Liver Institute
Harm Reduction Coalition
Hep B United
Hep C Alliance
Hep C Connection
Hep Free Hawaii
Hepatitis B Foundation
Hepatitis C Allies of Philadelphia
Hepatitis Education Project
The Hepatitis C Mentor & Support Group, Inc.
Hepatitis C Support Project / HCVAdvocate.org

Linkage to Care Consultants, LLC

National AIDS Treatment Advocacy Project
National Center for Transgender Equality
National Viral Hepatitis Roundtable
New York State Hepatitis C Coalition
New Yorkers for Accessible Health Coverage
The OASIS Clinic
Project Inform
Project SAFE
San Francisco Drug Users Union
San Francisco Hepatitis C Task Force
San Francisco Safety and Wellness Coalition
St. Ann's Corner of Harm Reduction
Texas Overdose Naloxone Initiative
Treatment Action Group
Trust for Americas Health
VOCAL New York
The Wall Las Memorias Project
Washington Heights CORNER Project


cc: MHPA members, MHPA Board of Directors