I-Team: Tufts Health Plan Changes Policy On Hepatitis C Treatments After Public Outrage
BOSTON (CBS) - Tufts Health Plan is changing its policy on covering life saving Hepatitis C treatments. The move comes after public outrage over the price of the Hepatitis Drugs.
The I-Team first raised the issue in January. That's when Nichole shared her story.
The 25 year old had been the victim of a crime and contracted Hepatitis C from the perpetrator.
The drug Harvoni, made by Gilead, would have likely cured her. However, Harvoni carries a price tag of $84,000 and Nichole's insurance company, Tufts Health Plan would not pay.
She contacted the I-Team after receiving her 3rd rejection letter from Tufts. The reason, essentially, was that she wasn't sick enough yet.
"The insurance companies want me to be stage 3 liver scarring," she said in January. "I'm 25 years old, relatively healthy, and if I get treated I could live a relatively healthy life."
Nichole's story touched a nerve. She testified before a legislative committee on a drug pricing bill. Tufts Health Plan representatives were there. She heard from others in the same position.
This week, Tufts changed its policy. Instead of waiting for patients to have severe liver failure before covering the drug that would cure them, they will now offer coverage of Harvoni to members with early stage liver disease.
A spokeswoman says the move comes "as a result of our continual review of criteria in light of emerging research and new clinical guidance; consultation with external physicians; FDA and other government agency policies and standards adopted by national specialty organizations."
Nicole learned about the change from I-Team reporter Lauren Leamanczyk. "I cried," she said after learning the news.
"For people to not have to get to that point before they get cured it's going to make a much healthier lifestyle for all these people," she said.
And while she applauds Tufts for taking action, she does believe it is the result of patients like her telling their stories.
"Unfortunately it took a lot of negative attention in order for Tufts to break from the guidelines that they had," Nichole said Wednesday.
Nichole says she is hopeful she will now be able to take Harvoni, a drug with a 95 percent cure rate.
However, she is not done with her advocacy. She is working with a group aiming to hold drug companies accountable for high prices.