Court Approves Settlement In Health-Related Class Action

In conjunction with the Center for Health Law and Policy Innovation of Harvard Law School and Edwards Law Group, a cross-office pro bono team secured a settlement with Texas Health & Human Services Commission (HHSC) to help expand access to prescription drugs that cure hepatitis C virus (HCV) for Medicaid enrollees throughout Texas. 

In the initial complaint for Coleman v. Wilson, our clients alleged that the HHSC prioritized financial concerns over their health by restricting coverage of direct-acting antiviral treatment (DAAs) for HCV to only those Medicaid enrollees with severe liver damage, even though the treatment results in a cure for nearly 100% for all individuals infected with HCV.

As a result of the lawsuit, HHSC rewrote its policy, expanding access to DAAs to Medicaid enrollees diagnosed with HCV regardless of liver damage, and removing sobriety and prescriber requirements for HCV treatment. The new policy came into effect on September 1, 2021. At a final fairness hearing in late November, the parties informed the court about the overwhelmingly positive impact of the new policy on Medicaid recipients throughout Texas, and the court granted final approval of the settlement from the bench, to be confirmed in a subsequent written order.  

“At stake in this lawsuit was the denial of fundamental medical treatment. We are satisfied that this settlement will result in immense positive public health benefits for Texas Medicaid recipients,” said Boston partner David Tolley, who led the Latham team.

HCV is a deadly communicable disease that, if left untreated, can lead to serious liver damage, infections, liver cancer, and death. Treatment guidelines confirm that DAAs should be available for “all patients with chronic HCV infection, except those with short life expectancies that cannot be remediated by treating HCV, by transplantation, or by other directed therapy.” This clinical guidance reflects the medical standard of care across the United States. By removing treatment access restrictions to DAA treatment, HHSC joins the vast majority of state Medicaid programs throughout the US that cover HCV treatment for beneficiaries. 

The Latham team also included Boston associates Avery Borreliz and Allison Carbonaro and Los Angeles associate Amanda Barnett.