On February 16, 2016, Washington Medicaid enrollees filed this putative class action against the Washington State Health Care Authority (WHCA) under 42 U.S.C. §1983 in the U.S. District Court for the Western District of Washington. The plaintiffs alleged that WHCA’s Hepatitis C (HCV) treatment policy violated Title XIX of the Social Security Act (also known as the “Medicaid Act”) by excluding qualified Medicaid recipients from medically necessary treatment, discriminating among similarly situated Medicaid recipients, and failing to provide treatment with reasonable promptness as required by 42 U.S.C. §1396. The plaintiffs sought a court declaration that WHCA may not apply policies that limit treatment of HCV with direct-acting antiviral medications (DAAs) to Medicaid enrollees. The complaint further sought an injunction to prevent any future or ongoing efforts by WHCA to use and enforce such policies.
Specifically, a named plaintiff enrolled in Medicaid was diagnosed with HCV. Her doctor prescribed a type of DAA that could effectively cure the disease in more than 90% of the individuals treated. But when she attempted to fill her prescription through her Medicaid coverage, WHCA denied the request because the drug was expensive. WHCA did not offer this plaintiff any other medication as an alternative to treat her HCV.
On March 18, 2016, the plaintiffs moved for a class certification and a preliminary injunction. District Judge John Coughenour granted plaintiffs’ Motion for Preliminary Injunction on May 27, 2016, enjoining WHCA from continuing to apply its 2015 HCV treatment policy in order to conform with existing state and federal Medicaid requirements.
On July 21, 2016, Judge Coughenour granted plaintiffs’ Motion for Class Certification after finding that the numerosity, commonality, typicality, and adequacy of representation requirements were all met. The Court certified the class as all individuals who 1) are or will be enrolled in WHCA’s Medicaid Program on or after October 10, 2014, 2) require HCV treatment with Harvoni or other similar DAAs, and 3) do not meet the coverage criteria for HCV medication adopted by WHCA in February 2015.
The parties then reached a settlement and on November 21, 2016, filed an joint motion for preliminary approval. Judge Coughenour preliminarily approved the settlement on January 5, 2017, and then held a fairness hearing.
On April 10, 2017, Judge Coughenour finally approved the settlement, finding it to be fair, reasonable, and adequate. The terms were: The 2016 Preliminary Injunction Order would remain in effect for three more years, with the Court retaining jurisdiction to enforce it; WHCA would pay each class representative $7,500 as a case contribution award, and class counsel was awarded fees and litigation costs totaling $343,394.
This case is closed.
Sichun Liu - 06/15/2020
compress summary
