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Kids with HCV get new drugs and coverage may prove easier than for adults

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Medicaid programs and private insurers have often balked at paying for expensive drugs that treat hepatitis C virus (HCV) for adults, but stricter Medicaid guidelines for children may make coverage more routine.

Medicaid programs and private insurers have often balked at paying for expensive drugs that treat hepatitis C virus (HCV) for adults, but stricter Medicaid guidelines for children may make coverage more routine. FDA approved on April 7 supplemental applications for sofosbuvir (Sovaldi—Gilead Sciences) and ledipasvir–sofosbuvir (Harvoni—Gilead Sciences) for the treatment of HCV in children aged 12–17 years. The drugs were previously approved to treat HCV in adults. When the new drugs were introduced a few years ago, insurers often balked at the price tag, which typically approached $100,000 for a course of treatment. Medicaid programs, in particular, restricted access to the drugs for adults, often requiring that people have significant liver damage and/or prove that they had been drug- and alcohol-free for several months before they would approve treatment. Insurance coverage may be less problematic for children, experts say. Under federal law, state Medicaid programs must cover "early and periodic screening, diagnostic, and treatment services" for children younger than aged 21 years that are necessary to correct or ameliorate physical and mental illnesses. "The short answer is that [Medicaid] will likely require coverage for all kids regardless of whatever the coverage policies for adults may be," said Matt Salo, executive director of the National Association of Medicaid Directors.

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