Cystic Fibrosis Drug Dropped By Arkansas Medicaid over Cost

US NEWS- Paul Gordon Collier- The Cystic Fibrosis Drug, Kalydeco, has been dropped by Arkansas’ Medicaid program, a suit alleges, over cost.  The drug, manufactured by Vertex Pharmaceuticals, costs $300,000 a year.

cystic fibrosis drug

The drug provides therapy for Cystic Fibrosis, which is an incurable, terminal lung disease.  The lawsuit was filed by three people afflicted with the disease.  They allege that state officials have violated both federal and state laws in denying coverage of the drug by Medicaid simply because it is too expensive.

Arkansas officials have not commented specifically on the allegations, but claim the access is restricted because data does not support Kalydeco should be a first option for treatment of the disease.

However, the plaintiffs’ attorney have obtained emails by officials that suggest cost was a deciding factor.  The officials wrote specifically about the worrisome cost of cystic fibrosis drugs both currently and futurely.

One government official stated, “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.”

One state spokeswoman said, “Cost alone was not the determining factor, but how we will pay for it is something we must consider in advance as we are a state agency with limited funds.”

Arkansas appears to be the only state in the nation to deny Medicaid coverage of Kalydeco.  Federal law requires all State Medicaid programs to pay for FDA-approved drugs.  The only mitigating circumstance is of there are other cheaper, comparable therapies available.  Kalydeco has no equivalent therapy available.  It is also an FDA-approved drug.

According to a Wall Street Journal article “Patients taking Kalydeco had an average lung function improvement of 10.1% after about 11 months, compared with a decline of 0.4% in patients taking placebo, according to data published in the New England Journal of Medicine in 2011.”

Other similar cases are emerging regarding other expensive drugs that have been not covered by Medicaid.  For opponents to government-run healthcare, cases like these accentuate their concern of government managing the winners and losers of healthcare services.  Proponents counter that without government managed healthcare, lower income people would be losers in that exchange all the way around.