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How to Afford HCV Treatment

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Some Hepatitis C patients may choose not to attempt antiviral therapy for many different reasons. However, with the resources available today, financial reasons can be excluded from deciding whether or not to receive treatment.

Some people are lucky enough to receive their Hepatitis C diagnosis while there is still time to do something about it. While absorbing the news that you are chronically infected with the Hepatitis C virus (HCV) may initially feel devastating, it beats not finding out until your liver is ready to shut down. Once a person discovers this virus lurking in their body, it is time to make decisions about receiving treatment. While many factors go into choosing whether or not to undergo antiviral therapy, its high cost may be less of an obstacle than most people think.

Choosing Anti-Viral Treatment

Aside from the financial burden, opting for the standard Western medical treatment consisting of pegylated interferon and ribavirin primarily hinges on two things: your state of health and your likelihood of progressing to cirrhosis or liver cancer in the future.

Anti-viral therapy is typically recommended if a person:

  • Is at increased risk of developing cirrhosis due to elevated enzyme levels for over six months
  • Has a high level of the virus in their blood, indicating an active infection
  • Has had a liver biopsy which shows significant liver damage

Anti-viral therapy is typically NOT recommended if a person:

  • Is not likely to develop cirrhosis, due to normal or only slightly elevated liver enzyme levels, and a liver biopsy showing little or no significant liver damage
  • Has another serious medical condition such as diabetes, an autoimmune disease, depression, heart disease or active substance abuse
  • Is pregnant

Best done in concert with your physician, deciding to try antiviral therapy for HCV involves many considerations. Some of the pros for this treatment are:

  • Antiviral medicine is currently the only approved treatment for chronic HCV.
  • The newer pegylated interferon medicine (combined with oral ribavirin) only needs to be injected once a week, rather than 3 times a week as is needed for standard interferon treatment.
  • Research has shown that those who complete treatment and have no detectable virus in their blood six months following treatment appear to be “cured.”
  • Approximately 50 percent of those with the most common HCV genotype in the United States, genotype 1, are able to achieve treatment success.

Some of the cons for this treatment are:

  • Approximately 50 percent of those on the medicines develop significant side effects including fever, fatigue, muscle-aches, anemia and depression.
  • Those who discontinue the treatment due to the side effects have a lower chance of treatment success.
  • Studies on the effectiveness of anti-viral treatment have not been done on people who have other serious conditions.
  • You will not be able to perform your job or take time off if you have significant side effects from the medicines.
  • Approximately 50 percent of those with the most common HCV genotype in the United States, genotype 1, are able to achieve treatment success.

After weighing the treatment’s pros and cons, a decision to proceed is often met with concerns about how to pay for the high-priced medications. As it turns out, there is a way for most people who need and want the treatment to financially afford it.

Affording Treatment

Proper physician care and the cost of medications for HCV can both cost a lot of money. A representative from the pharmaceutical company Schering-Plough estimated the cost of antiviral medication averaged between $2,000 and $3,500 per month. While health insurance offsets this burden, data from the 2006 U.S. National Health Interview Survey show that 14.8 percent of Americans, or 43.6 million, do not have health insurance. Whether you do or do not have health insurance, there are many resources available in the United States for helping people afford HCV therapy. The more common options are listed below:

  1. Private Health Insurance – Most private insurers provide coverage for all necessary care and medications. Depending on the company and plan, co-pays or deductibles may be necessary out-of-pocket expenses. Please note, if you must pay for a portion of your medication costs, shop around between pharmacies. The price of these drugs can vary widely between mail order companies, small pharmacies and big chain stores.
  2. Medicaid – The federal and state public insurance program for low-income people meeting eligibility requirements, Medicaid programs cover HCV treatment in every state. However, the enrollment criteria, amount that you pay for prescription drugs, the number of drugs you can get in one month and the requirements to get drugs usually differ between states.
  3. ADAP – For those co-infected with HCV and HIV, the AIDS Drug Assistance Program (ADAP) is a state and federal program that serves people living with HIV who are uninsured or underinsured. While eligibility criteria varies state to state, ten ADAPs provide access to both ribavirin and peg-interferon for those co-infected with HIV and HCV.
  4. State Programs – Many states have HCV assistance for those in financial need. While it may take a bit of investigative work, a simple phone call to your state’s Department of Health and Human Services Department can reveal programs for helping afford the cost of physician care and HCV antiviral medications.
  5. Patient Assistance Programs – If unable to access care through the previously described routes, both the manufacturers of the peg-interferon (Schering-Plough) and ribavirin (Roche Pharmaceuticals) have patient assistance programs. If a person meets these programs’ eligibility requirements, they may be able to receive the medications at a low-cost or for free. If in need, call the Schering-Plough Patient Assistance Program at 1-800-521-7157 and/or the Roche Patient Assistance Program at 1-877-757-6243.

Determining eligibility for one of the many programs will definitely involve paperwork. However, it can exclude financial need as a criterion for choosing to begin HCV antiviral treatment. Although antiviral treatment may not cure someone of the Hepatitis C virus, it proves worthy to some of those who can endure it.

Learning you have HCV before it progresses to the end stages of liver disease affords someone the option of choosing anti-viral therapy. If this route is chosen, there are many ways to finance the medications. Whether a person with HCV is insured, underinsured or uninsured – investigative effort, follow-up and filling out paperwork are sure to erase money from the anti-viral therapy pros and cons list.

References:

www.cdc.gov, Uninsured Americans: Newly Released Health Insurance Statistics, Center for Disease Control and Prevention, 2007.

www.schering-plough.com, Patient Assistance and Support Programs, Schering-Plough Corporation, 2007.

www.thebody.com, Access to Care and Treatment for HCV, WISE Words, The Body, August 2003.

www.webmd.com, Should I take antiviral therapy for hepatitis C?, WebMD, Inc., 2007.

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