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Insurer drops drug screen requirement for hep C coverage

September 13, 2016
by Tom Valentino, Senior Editor
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UnitedHealthcare will no longer require clean screenings for alcohol and drug use before providing policyholders with coverage for Harvoni (ledipasvir/sofosbuvir), a drug used to cure hepatitis C. The move comes as part of a  $300 million settlement in a nationwide class action lawsuit.

As part of the deal, which was first reported Monday by Daily Business Review, United has expanded its formulary to include more robust coverage of hepatitis C drugs. The cost for an eight-week course of therapy with Harvoni, which has been found to cure hepatitis C in up to 99% of cases, is listed at $63,000.

Given the high cost of new drugs used to treat the virus, insurers have been particularly stringent in approving coverage. Prior to the settlement, United required policyholders to prove they had been abstinent from drugs and alcohol for six months. That requirement now will be replaced with a physicians’ treatment readiness review, pending approval of the settlement by a U.S. district court judge.

The lawsuit in the case was originally filed in May 2015 by a Pompano Beach, Fla., woman who was prescribed Harvoni by her gastroenterologist but was declined coverage by United, which had chosen to cover Harvoni only for patients whose hepatitis had progressed to severe liver disease. That restriction was later removed.

Behavioral health clinical leaders note that no other disorder disqualifies individuals from receiving treatment and therefore, screening for substance use disorders prior to hepatitis C treatment fails to follow longstanding parity laws.