The eligibility requirements for drug coverage under state Medicaid programs, such as Medi-Cal, California's Medicaid program, sometimes limit who is entitled to highly expensive medicines, Capital Public Radio reported in a Feb. 9 article. In California, these restrictions allow only those with severe liver disease to get coverage for the kind of $85,000 per course treatment that those suffering from Hepatitis C, a disease that also affects the liver, need.
Professor Robert Field, an expert in health care law, including medicare regulations, claimed that these limitations give certain drug companies a monopoly, thus preventing the kind of competition that would normally drive down high price tags for drugs.
"We’re going to see this issue more and more, and at some point, something’s going to have to give," Field said.
"Either there’s going to have to be a change in the way pricing is done, or we’re going to have to have more rigorous standards for who can get what," Field claimed.