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Hepatitis C Lawsuit
As part of an agreement to settle a lawsuit, the Michigan Department of Health and Human Services (MDHHS) is changing its coverage requirements for Direct Acting Antivirals or DAAs. DAAs treat Hepatitis C. This webpage provides beneficiaries with information about the settlement and related coverage changes.
What was the lawsuit about?
A Medicaid beneficiary asked MDHHS to cover a DAA and MDHHS denied that request. This beneficiary filed a lawsuit and said that MDHHS was not following federal guidelines for DAA coverage. The case is called M.R v. Lyon, and the case is No. 17-cv-11184.
Both sides agreed to settle the lawsuit, and a judge approved the settlement and the award of attorney fees on August 31, 2018.
What are the terms of the settlement?
MDHHS is changing the way it looks at fibrosis scores when deciding whether to cover DAAs for people on Medicaid. A fibrosis score measures damage to the liver. Starting October 1, 2018, people with a fibrosis score of F1 or higher will have access to DAAs even if they don’t have other health problems. On October 1, 2019, MDHHS will expand this further to include people with a fibrosis score of F0 or higher.
Other requirements for DAA coverage still apply.
What happens next?
Starting on October 1, 2018, MDHHS will expand coverage as directed by the settlement agreement and update its DAA approval forms. MDHHS also sent a letter about the settlement with a DAA approval form to class members.
For questions about the settlement, contact Aaron V. Burrell of Dickinson Wright, PLLC, at 312-223-3500.