Lawmakers consider controversial changes to reduce KanCare drug costs

Committee OKs draft recommendations that include proposal to withhold hepatitis C treatment from ‘noncompliant’ patients

By Jim McLean, December 30, 2015

A legislative oversight committee has approved a controversial set of draft recommendations aimed at reducing the cost of drugs provided to Kansas Medicaid recipients.

The joint committee that oversees the state’s privatized Medicaid program known as KanCare this week tentatively approved recommendations that direct the Kansas Department of Health and Environment to develop policies aimed at slowing a steady increase in the $3 billion program’s pharmacy costs.

The most controversial of the recommendations calls for withholding expensive hepatitis C drugs from KanCare recipients who don’t follow treatment requirements, such as patients who fail to take all their pills or consume nonprescription drugs or alcohol during treatment.

Sen. Jim Denning, an Overland Park Republican, said Kansas taxpayers shouldn’t have to pay for repeated treatments when patients knowingly engage in behaviors that undermine the effectiveness of their medications.

“I know it is pretty strong language,” Denning said. “But if we have patients that are abusing an $80,000 drug, then there have to be consequences.”

Hepatitis C is a liver infection caused by a virus spread through the exchange of blood or other bodily fluids.

The wholesale cost of a standard 12-week treatment for hepatitis C can range from $84,000 to $94,000 depending on the drug. Through the first four months of the fiscal year, KanCare has spent approximately $3.1 million on hepatitis C treatments, according KDHE documents.

Democrats on the committee objected to Denning’s proposal, saying it would be tantamount to imposing death sentences on noncompliant patients.

“It just seems like we’re making life and death decisions, and I’m just very uncomfortable with that,” said Sen. Laura Kelly of Topeka, the ranking Democrat on the committee.

Republicans who control the committee disagreed, saying the state has a responsibility to both KanCare recipients and taxpayers.

“We’re not sentencing people to death,” said Sen. Mary Pilcher-Cook, a Shawnee Republican and chairwoman of the oversight committee. “If a patient is noncompliant, they are making a decision.”

Members voted 5-2 to include the proposal in a set of draft recommendations that the committee is expected to finalize at the start of the 2016 legislative session in January.

Panel members also endorsed a proposal to allow the three private insurance companies that manage KanCare to implement step therapy protocols. If lawmakers approve the change, the insurers could restrict providers’ ability to prescribe expensive drugs to patients in the general KanCare population unless cheaper alternatives had been tried and proven ineffective.

The committee also asked KDHE officials to compile a report on the extent to which certain behavioral health drugs are being overprescribed. Legislators are concerned about reports that powerful antipsychotic drugs are being inappropriately prescribed to children and used for the “off label” purpose of controlling the behavior of dementia patients in nursing homes.

A law passed earlier this year allows the state and the KanCare companies to establish a preferred drug list for mental health drugs. State officials are working with a stakeholder advisory committee to implement the change. 

The nonprofit KHI News Service is an editorially independent initiative of the Kansas Health Institute and a partner in the Heartland Health Monitor reporting collaboration. All stories and photos may be republished at no cost with proper attribution and a link back to KHI.org when a story is reposted online.

http://www.khi.org/news/article/lawmakers-consider-controversial-changes-to-lower-kancare-drug-costs#sthash.FbiY5rtq.dpuf

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