Statement from Paul Macielak, HPA President & CEO
“The New York Health Plan Association (HPA) and its member plans have had an ongoing discussion with regulatory agencies including the Department of Health, Department of Financial Services and the Attorney General’s office related to plans’ development, use and application of evidence-based guidance in their coverage criteria, including for Hepatitis C, and the role of evolving guidelines in ensuring all patients have access to appropriate treatments.
“When newer drugs come on the market, clinical guidance issued by professional societies and government is reviewed and amended. As clinical standards evolve, so too do coverage policies.
“Today’s announcement by the AG acknowledges the newest consensus approach to plan policies that assures everyone — patients and their providers, plans, and New York’s health policy makers — is aware of and understand the process for setting plan medical necessity criteria related to Hepatitis C treatment.
“The fact remains, however, that newer drugs being used to treat Hepatitis C are exorbitantly expensive. Their high prices continue to be a major factor driving up the cost of pharmacy benefits and increasing the overall cost of health insurance to hundreds of thousands of individual New Yorkers and small businesses. HPA believes New York should focus on affordability by taking a more aggressive position on the excessive pricing of these Hepatitis C drugs. We are committed to working with state policy makers and the AG’s office on this effort that would produce genuine benefits for New York consumers.”