Iowa Medicaid Director Mike Randol discusses hepatitis C requirements for members

IOWA CITY - Iowa Medicaid Enterprises is implementing a new guideline to make hepatitis C treatment more accessible to Medicaid members, its director announced Friday during an Iowa City summit.

But some attending the Iowa Harm Reduction Summit said Iowa's program still will restrict certain members from treatment access, leading to higher rates of liver disease and complications, and higher costs down the road.

Iowa Medicaid Director Michael Randol discussed hepatitis C treatment access among Iowa's Medicaid members during the third-annual Iowa Harm Reduction Summit at Old Brick Church, hosted by the Eastern Iowa Coalition, a not-for-profit.

Randol was joined in the discussion by Dr. Donald Hillebrand, medical director of the center for liver disease at UnityPoint Health-Des Moines.

Friday's summit, which served as a conclusion to the weeklong event and included several panels, was attended by about 250 people, officials said.

The goal of the summit was to bring together experts and individuals working on the opioid overdose crisis in Iowa and to create a plan going forward for some of the facets of those efforts. Those include overdose prevention, syringe exchange program and hepatitis C treatment, said Sarah Ziegenhorn, founder and executive director of the Coalition.

'As we see more and more people getting hepatitis C in Iowa, we've also seen that it's really hard to treat them,” Ziegenhorn said. 'We want to create some change within Iowa Medicaid's policies when it comes to hepatitis C treatment access.”

Rates of hepatitis C, a viral infection of the liver, has increased 1,100 percent from 2000 to 2016 in Iowa in those under the age of 40, Hillebrand said during the discussion.

He cited the growing prevalence of injection drug use and a concerning trend of individuals sharing needles, which increases the risk of transmitting and contracting the virus.

If left untreated, the disease will cause scarring of the liver, which can lead to liver disease or liver failure in the most severe case, Hillebrand said.

Treatment is available and effective in curing infected individuals.

For Medicaid members to receive the treatment, they have to meet specific requirements set out by the Medicaid program and the managed-care organizations that oversee individual coverage, Randol said.

However, it's these very requirements, Hillebrand noted, that make Iowa one of eight states that do not follow national guidelines for hepatitis C treatment, making it among the worst nationwide for access.

Hillebrand citied two federal guidelines with which Iowa did not comply - a Center for Medicare and Medicaid Services letter issued to states that asked for improvement in treatment access for members, and a federal law mandating Medicaid programs provide coverage for medications unless excluded for non-medically justifiable cases.

'Now that the cost of these drugs has dropped 75 percent, we need to take advantage of that and make sure we don't have more hepatitis C in 10 years than now because we're not treating early stage liver disease in people that are still injecting drugs,” Hillebrand said.

Medicaid members have to have a fibrosis score - the measure of the scarring on a liver - of three or more. In addition, they must document three months' of sobriety from alcohol or drug use.

Randol said during Friday's summit that Iowa Medicaid Enterprises submitted a rule change within its latest budget proposals to lower the fibrosis score to 2 beginning January 2019.

As far as the other requirements, Randol said he and his staff 'will go back and evaluate.”

'It's a continual process to evaluate as new medicines are introduced, new procedures, so we will continue to evaluate,” Randol told The Gazette following the discussion.

Hillebrand said Iowa Medicaid isn't shying away from treating members with hepatitis C, but 'we just need to do better.” These requirements are shifting the burden of the disease onto those younger than aged 40, who are more likely to be using injection drugs, he said.

'There are more Iowans we can help,” Hillebrand said.

According to national guidelines Hillebrand cited during his talk, states' Medicaid programs are encouraged to have a fibrosis score of 1 or 0 and not to require sobriety documentation - neither of which are proven to be 'medically necessary indications,” he said.

Randol received some heated pushback from the 30 or so members of the audience on this topic after he stated Iowa Medicaid Enterprises would continue to evaluate these requirements.

'I think what we have to understand is, as Medicaid director, I have to focus on 600,000 Iowans and we have to have a sustainable program five to six to seven years,” Randol said.

'We have to have a sustainable program. We cannot continue to grow at a certain rates.”

Hillebrand encouraged more transparency from the Iowa Medicaid director on the process of implementing a prior authorization.

'It would be helpful for us to know the steps on how it gets there, so we can intervene,” he told The Gazette following Friday's discussion.

l Comments: (319) 368-8536; michaela.ramm@thegazette.com