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Who Is Getting Hep C Treatment?

July 28, 2016

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Hepatitis C medications are highly effective, but many patients are unfairly excluded from receiving treatment.

The Hepatitis C virus causes progressive liver damage and is the leading cause of liver transplants in the U.S., yet its gravity is frequently disregarded. According to the U.S. Centers for Disease Control and Prevention, more people die from Hepatitis C than from 60 other infectious diseases combined. Despite major advances in Hepatitis C treatment, many are not receiving the new, potentially life-saving drugs.

The pharmaceutical industry has made significant progress in Hepatitis C treatment over the past few years. Our ability to rid people of the Hepatitis C virus is greatly improving, with many drug combinations boasting cure rates between 90 and 99 percent. However, not everyone is getting this valued Hepatitis C treatment.

Up until 2013, the most common treatment for Hepatitis C was riddled with severe side effects, was difficult for many patients to tolerate and plateaued at a 50 percent success rate. By the end of 2013, medications with fewer serious side effects and a higher success rate started becoming available. Sovaldi was the first, new Hepatitis C medication to be approved by the FDA and, later in 2014, Harvoni became available as the first drug that could eliminate symptoms without the need for a second drug. Both Solvadi and Harvoni became known as being among the most expensive drugs sold in America.

In May 2016, a report from the Center for Improving Value in Health Care found that in spite of the availability of new, revolutionary drugs, 89 percent of Colorado residents with Hepatitis C did not receive any treatment for their condition. The study analyzed claims data from the Colorado All Payer Claims Database for the commercially insured (excluding those on self-insured plans), Medicaid and Medicare Advantage members in 2013 and 2014.

  • Before the FDA approval of Sovaldi in late 2013, only four percent of Colorado residents received medication for Hepatitis C.
  • When the new drugs became available, seven percent of Colorado residents received the new treatment, while four percent remained on the old regimen.
  • Thus, about 89 percent of Colorado residents with Hepatitis C still were not receiving any treatment as part of their health care insurance benefit.

It appears that the cost of the new Hepatitis C drugs is responsible for the limited number of people being treated. List prices for Hepatitis C medications typically range between $80,000 and $120,000 for a three- or four-month course. Considering that over three million Americans are believed to have chronic Hepatitis C, it’s easy to see how treatment for everyone would easily bankrupt health insurance companies.

The Struggle to Obtain HCV Treatment

In a recent article printed in the Philadelphia Inquirer, the struggle to obtain Hepatitis C treatment is exposed. In the article, a Pennsylvania resident describes his story, where his Medicaid insurer denied coverage of Hepatitis C treatment two separate times. According to the source, Medicaid informed the patient that he was not ‘sick enough’ to be approved for treatment.

This denial strategy is clearly due to the financial burden of treatment. Patients, doctors and insurers are all hoping that new drugs will raise the competition and finally allow for costs to drop. Waiting for patients to get sicker, however, is not a sound strategy.

According to Ashraf Malek, a liver specialist with Lourdes Medical Associates, “It is better to get treated [earlier] and pay for it rather than wait until somebody gets sick and gets a liver transplant.” Although the treatments have a high rate of success at any stage of Hepatitis C infection, they won’t fix late stage liver damage (like cirrhosis or cancer) that it causes, leading to higher costs overall.

In response to unfair Hepatitis C treatment denial practices, an advisory committee just voted to make treatment available to all Hepatitis C-infected patients on Medicaid in Pennsylvania. If approved by the Department of Human Services Secretary, the state would join a handful of others that have eased restrictions.

Although typically more progressive on social services issues, New Jersey remains among the most restrictive on Hepatitis C treatment coverage. The state leaves decisions up to its managed-care contractors, which generally require evidence of severe fibrosis (a score of F-3 on a scale of 0 to 4), to cover treatment. Standard medical guidelines recommend treatment beginning with a score of F-0.

A result of its extreme cost, the issue of who gets Hepatitis C treatment is posing a major challenge in our society. Nonetheless, lawmakers are pushing insurers to stop the denials:

  • The Veterans Administration announced in March of 2016 that it would treat all veterans with Hepatitis C.
  • The federal Centers for Medicare and Medicaid Services sent a reminder to states in November 2015 that Medicaid programs, run and funded jointly with the federal government, are required to meet accepted medical standards.
  • Harvard’s Center for Health Law & Policy Innovation is pursuing a class-action lawsuit against Washington State for withholding Hepatitis C treatment.

An insurance company placing restrictions on who is awarded Hepatitis C treatment benefits is merely responding to the extreme financial weight of these drugs. Whether from Colorado, Pennsylvania, New Jersey, Washington State or elsewhere, the large number of people with Hepatitis C who are not granted treatment is very high. Until modern medicine is able to reconcile between the pharmaceutical industry, the insurance industry and people with the virus, Hepatitis C treatment denials will continue – and this virus will maintain its title as the leading cause for liver transplants in the U.S.

http://hepatitiscnewdrugs.blogspot.com/2016/05/study-shows-nearly-90-percent-of.html, Study Shows Nearly 90 Percent of Coloradans Diagnosed With Hepatitis C Go Untreated, HCV New Drug Research, 2016.

http://www.philly.com/philly/news/20160522_How_sick_must_hepatitis_C_patients_be_to_get_help_.html, How sick must hepatitis C patients be to get help?, Don Sapatkin, Philadelphia Media Network, LLC, 2016.

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HepatitisCentral.com provides information regarding hepatitis and liver disease. Comments are available to the community in order to discuss these topics and obtain answers to questions through community members. The Editors at HepatitisCentral.com will not be responding to questions or comments posed in article comments.

  • mary104

    I’m not getting treatment and I’m waiting and seeing a GI specialist for over 4 years I go every 3 months just to hear soon. I’m already sick with many symptoms. I’m on Medicate and insurance doesn’t care if you’re not rich enough to pay then you die with it.
    Some help for disabled

    • Amr Zaky

      Check with the department of gastroenterology/hepatology at the university of Michigan Ann Arbor in Michigan bcz they will make sure that you will get the treatment. I got the treatment and I am so far virus free for $5 copay

    • Brama

      Might I suggest going to www . Fixhepc . Com.

  • Amr Zaky

    I received Harvoni last December and company made me pay $5 only as a copay by mailing me a coupon. All RNA tests so far indicate absence of virus and my liver enzymes so far are normal. I still have one more test this coming November and I hope that it will remain negative as previous ones.
    I thank you guys for your news letters bcz they were of great help and I still read them.

  • Sandy Robertson

    Thank god for the UK health service. I still had to wait for Harvoni for few years, but halfway through an 8 week course I already feel better. It’s only 2 months as I haven’t been subjected to interferon as my consultant warned me against it, so being treatment naive I need less meds. No side effects at all.

  • Michelle Lee

    OH and I had the OLD treatment back in 2012. It was hard too. self administered injections once a week and then a strict regimen of three diff pills and restrictions on food when taking the pills. UGH ….I wonder if it’s cheaper to use those and just tell ppl well we can treat you for this low amount and it’s a drag or you can not get treatment with the new stuff until someone can pay for it. bummer

    • p

      me too.. in 2002 and it killed my neutrophils..so i had to quit and then rebounded viral load.. SuCKS

  • p

    since i’m genotype 3 this new stuff won’t work for me.. without other pills added and ends up being long (48 week) treatment with a cost of about quarter million

    • Tig

      Epclusa w/wo Voxlaprevir is very effective against GT3. There are no 48 week treatments left. Check the AASLD guidelines.

      • LizMarie

        To all: I have had both treatments. At 45 I was diagnosed in 1999 with Hep C, Geotype 1A Grade 1. I waited until 2005 to take the Interfernon/Riberviarn, because I felt ok and the Interferon at that time was only a 40% chance or working. The virus caused me to become very ill over the next 5 years. I had to quit my career before I had planned to retire and was not prepared financially to be on disability. I ended up going through all my savings and at the time I had to start the Interferon in 2005, I had no insurance and no job and was denied disability by the State. Through a support group I was
        attending I found out that many of the pharmaceutical companies have programs available to help people that were in my position.
        I encourage anyone who is fighting with their insurance company or Medicare to approve treatment with the new Harvoni; Call the pharmaceutical company and tell them your story. There is help out there if you are persistent, patient and willing to tell your story over and over again. My virus returned in 6 months, I then had to wait 5 more years for the Harvoni to be approved. But in the meantime the HCV took a toll on my body. I was in and out of the hospital for those 5 years for several types of internal problems caused directly from the HCV. In 2008, I was diagnosed with non hodgkins lymphoma, caused by the HCV. After chemo, the cancer cleared, but returned 2 years later. In 2011 I went through chemo again. And am now am a 2 year maintenance chemo program.
        The good part of the this long drawn out story is that last October 2015, I was approved for the 12 week Harvoni treatment. Again, I was approved through a program that was available for those of us who are financially not able to pay $1000 a pill.
        I encourage anyone who may be in this position, to seek information through the pharmaceutical companies for any special programs available.
        I hope this information may help or/and encourage anyone to reach out for help.
        Blessings to you all.
        LizMarie

        • Chris Marsh

          I was diagnosed in January 2016. Ithe seemed like waiting on insurance wasn’t my best option. I made an appointment with a reputable physician in India. Got a prescription after appointment, began treatment within a couple days. Well worth the cost of travel and medications. I’d still be waiting to 2017 ?+, for treatment.

  • Leslie Sears

    Just want you’ll to know. I HAD HepC. Yes, I was in the more advanced stage of the disease. I have to say that Kaiser has really stepped up to the plate. I took the med for 8 weeks. Have been virus free for a year. The continue to follow me every 6 mths with labs and ultrasound of liver. I also have been a research coordinator with the major drug companies for many years. I understand why the drug is so expensive, but they will have met their patent date before long and everyother company will come out with a “me too” drug and the price will go way down. Little explanation. When a company stars research a drug, they get an 11 year patent. When the patent expires then the generics, etc. are released. That means that the company who spent millions on development only has a very short time to recoup it’s expense Often it takes up to 10 years to reseach and get the drug though the FDA. Sad, but true. I actually think a govn that can send a ton of money to other countries that chant “death to America” could subsidize the Harvoni until the price goes down. This is an epidemic and will continue to be so until it is irradicated.

  • Dee

    I am from GA I have been recently diagonised with GT3 my Dr prescribed Eclusa but my insurance has denied me. I applied and received the $5 copay coupon, but I am stuck not having the funds and I dont know where to go next. Can anyone help

  • jarat

    Anyone can get the newest Hep C drugs like I did for a fraction of the standard costs that are listed here in the US. Contact this guy who lives in Australia. He will arrange with you to get the generic and equally potent drugs from India. That’s what I did– I got six months treatment (sofosbuvir + daclatasvir) for my GT-3. I’ve been “not-detected” for six months now and will continue to get monitored once per month until May, 2017.
    http://hepatitisctreatment.homestead.com
    Read his full story–he’s legit.

    BTW, I also did a 4 month sofosbuvir + daclatasvir course before this 6 month one, and the HCV was back within a month of ending. I found out that GT-3 patients were now being recommended to do the 6-month. I also failed a 6-month interferon + ribavirin course a few years ago.

    I’m hoping that the current not-detected results stay (-) for another 5-6 months.

    Joe