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NY attorney general enters agreement with 7 insurers to expand hepatitis C coverage

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NY attorney general enters agreement with 7 insurers to expand hepatitis C coverage

New York Attorney General Eric Schneiderman on April 26announced an agreement with seven health insurance companies to revise theircoverage policies for chronic hepatitis C treatment.

The insurers are Affinity Health Plan, Empire BlueCrossBlueShield, Excellus Health PlanInc., HealthNow, Independent Health, United Healthcare/Oxford andMVP Health Plan Inc.

Prior to the agreement, five of the seven insurers limitedchronic hepatitis C coverage to members with advanced liver scarring or othercomplications. Following these agreements, each of those insurers willeliminate restrictions requiring members to have advanced disease before theirtreatment will be considered "medically necessary" and covered by theplan. Additionally, prior to the agreement, four of the insurers deniedcoverage of treatment based on the members' use of alcohol or other drugs, andthree of the insurers permitted only specialists to authorize treatment. Theseinsurers have now agreed to not deny coverage based on members' alcohol or druguse and to permit appropriately trained providers to authorize treatment.

The seven health plans must fully implement the revisedcriteria within 45 days of the agreement and will send notices to members whowere denied coverage who may now be eligible for treatment.

Schneiderman recently filed a against , alleging that the company unlawfully restricted coverage oftreatment for chronic hepatitis C infection. The office had also health insurers inthe state as part of a hepatitis C drug coverage probe.