Hep C Discussion Forum

From USA TODAY March 3, 2014:

"State Medicaid agencies are just now beginning to react to the implications of the two new medicines. The majority of Medicaid beneficiaries are in managed care plans, but those managed care plans set their capitation rates (the amount Medicaid pays managed care plans per patient in a year) for 2014 before the FDA approval of simeprevir and sofosbuvir. Now, some of those plans are asking their state Medicaid agencies for a carve-out or "pass-through" for these drugs, meaning that the Medicaid agencies would bear the costs of those drugs above the capitations. The states could also try to negotiate with the manufacturers for a better price.

"This is going to fall on taxpayers because we think it will fall disproportionally on those in Medicaid," said J. Mario Molina, chief executive of Molina Healthcare Inc., a Medicaid managed care plan with 2.1 million beneficiaries in California.The potential costs of these drugs could overwhelm the Medicaid agencies, forcing them to turn to their legislatures for additional money."

Article:  http://www.usatoday.com/story/news/nation/2014/03/03/stateline-hepatitis-c-drugs-health-care-spending/5973133/