The Wall Street Journal examines in depth today a federal lawsuit in Arkansas over the state Medicaid program’s denial of coverage for an expensive drug to treat three plaintiffs with a rare strain of cystic fibrosis.

The drug, Kalydeco, costs $300,000 a year. A coming improved version might cost more. Arkansas has said the patients denied the drug coverage first must prove that older therapies are ineffective, a requirement that their lawyers say is contrary to recommended protocols and a denial of their civil rights.

Advertisement

State-mail dug up by lawyers show that cost has been a prime concern of state officials. Expensive new drugs are presenting dilemmas for Medicaid agencies across the country, the article notes. Said Matt Salo, executive director of the National Association of Medicaid Directors, a professional association:

We have this public health mentality that all people have to be cured no matter what the cost, and also let the innovators charge whatever they want. Those are fine theories independently, but when you combine them together in a finite budget environment, it’s not sustainable.

Discussions in Arkansas are illustrative.

Advertisement

In a series of 2012 emails obtained by Chloe’s attorneys and reviewed by The Wall Street Journal, Arkansas Medicaid officials discussed Kalydeco’s cost. In an email to colleagues discussing a review board’s deliberations about Kalydeco, a pharmacist named Pamela Ford wrote, “the consensus of the physicians on the board was that none of the prescribers would have a clue that this will cost AR Medicaid $303,408 per patient per year.”

She also noted in a separate email that Vertex was working on a new product that would combine Kalydeco with another drug, which could treat the majority of cystic fibrosis patients. The new therapy would be “likely even more expensive” and a “budget-breaker!” Ms. Ford wrote. “So we will be very strict in these reviews knowing it will come back even worse the next go-round.”

The kicker is the article close:

Brian O’Sullivan, a cystic-fibrosis specialist at University of Massachusetts Medical School, said the consensus among doctors is that all patients with the genetic defect should receive Kalydeco. Dr. O’Sullivan and other doctors criticized Vertex’s pricing of the drug in 2012, saying the company was “leveraging pain and suffering into huge financial gain.” But he called Arkansas’s policy “unconscionable.”

The plaintiffs are Chloe Jones, 14, and Elizabeth West and Catherine Kiger, both 21.

Advertisement

Be a Part of the Fight

Step up and make a difference by subscribing or donating to the Arkansas Times, the progressive, alternative newspaper in Little Rock that's been fighting for truth for 50 years. Our tough, determined, and feisty journalism has earned us over 63,000 Facebook followers, 58,000 Twitter followers, 35,000 Arkansas blog followers, and 70,000 daily email blasts, all of whom value our commitment to holding the powerful accountable. But we need your help to do even more. By subscribing or donating, you'll not only have access to all of our articles, but you'll also be supporting our efforts to hire more writers and expand our coverage. Join us in the fight for truth by subscribing or donating to the Arkansas Times today.

Previous article UPDATE: Little Rock Mayor Stodola announces for re-election Next article How much money is necessary for happiness?