Governor Andrew M. Cuomo today announced the nation’s first strategy to eliminate hepatitis C, including the establishment of a Hepatitis C Elimination Task Force that will advise the state as it implements its plan going forward. The elimination effort aims to stop the spread of the virus by increasing access to medications that can cure hepatitis C and expanding programs to connect New Yorkers with prevention, screening and treatment services. Hepatitis C, or HCV, is a liver disease caused by the hepatitis C virus affecting more than 200,000 New Yorkers.
“This holistic, first-in-the-nation approach to eradicating hepatitis C is modeled on our ongoing efforts to end the AIDS epidemic, and will improve the health of many of the most vulnerable among us including people battling drug addiction,” Governor Cuomo said. “We are going to end hepatitis C in New York State.”
Hepatitis C-related deaths have exceeded HIV-related deaths in the state outside of New York City since 2007, and with injecting drug use as the most common risk factor, the opioid epidemic has fueled a rise in new hepatitis C cases. The state will deploy “harm reduction” strategies that incorporate a spectrum of tools including safer use, managed use, and abstinence to help people who use drugs gradually improve their situations in a realistic way.
“This first-in-the-nation plan to combat Hepatitis C will provide funding to expand treatment options and increase access to medications,” said Lieutenant Governor Kathy Hochul. “More than 200,000 New Yorkers are living with the disease despite having the treatments available to cure it. New York is committed to investing in services to ensure that all New Yorkers have the access they need to treatment in order to live healthier lives.”
Hepatitis C Elimination Task Force
In 2017, state and national leaders gathered in Albany for the nation’s first hepatitis C Elimination Summit, where public health experts, advocates, and community stakeholders came together to develop a consensus statement on eliminating hepatitis C in New York State. The new Hepatitis C Elimination Task Force Governor Cuomo announced today will build upon that consensus statement and will provide expert advice to the State as it implements its plan to eliminate hepatitis C moving forward.
The new Task Force will be comprised of a Steering Committee and five subcommittees that will focus on priority areas, including prevention; care and treatment access; testing and linkage to care; surveillance, data and metrics; and social determinants. Subcommittee members will include consumers, community members, providers, researchers, harm reduction and social service providers, payers and public health staff.
Increasing Funding for Hepatitis C Programs
To increase access to hepatitis C medications, the Governor is announcing $5 million in new funding for hepatitis C services, such as education, patient navigation, and care and treatment programs in harm reduction settings. One in four people with HIV is co-infected with hepatitis C, and studies show that over 90 percent of people who are treated can be cured of the disease. New direct-acting antiviral drugs have minimal side effects and can prevent the need for a liver transplant, cirrhosis, liver failure, liver cancer or death.
Over the past decade, there has been a shift in the distribution of hepatitis C cases. In 2006, most reported cases of chronic hepatitis C were among the “baby boomer” cohort. By 2016, the age distribution had shifted, with a distinct peak emerging among a younger cohort of people aged 20 to 40.
The funding allocated for New York State’s hepatitis C elimination strategy addresses the needs of disproportionately impacted populations, specifically people who inject drugs and people who are incarcerated. The state will:
- Establish a patient navigation program within Syringe Exchange Programs to link persons with hepatitis C to care and treatment.
- Develop innovative hepatitis C treatment models targeting people who inject drugs that include co-located medication-assisted treatment along with hepatitis C treatment.
- Expand services to criminal justice populations to link inmates with hepatitis C to care, treatment and supportive services upon release from incarceration.
- Enhance hepatitis C surveillance to track the epidemic, inform program development, and establish and monitor hepatitis C elimination targets.
Expanding the State’s Hepatitis C Treatment Capacity
Governor Cuomo also directed the New York State Department of Health to implement new policies setting out specific requirements for approval of primary care licenses in harm reduction settings. This will expand the network of hepatitis C treatment providers and ensure availability of onsite hepatitis C treatment and medically assisted treatment for opioid use disorders. The Department will also issue regulations allowing OASAS and OMH licensed treatment providers to offer primary care, including hepatitis C treatment, to the people they serve.
First-in-Nation Authorization of Medicaid Reimbursement for Harm Reduction Services
Medicaid fee-for-service and Medicaid managed care plans began covering harm reduction services, effective July 1, 2018, making New York the first state in the nation to do so. This change applies to mainstream Medicaid managed care plans, HIV Special Needs Plans and Health and Recovery Plans. Harm reduction services will be delivered by syringe exchange programs authorized by the NYS Department of Health. Billable services include: Development of a Plan of Care; Individual and Group Supportive Counseling; Medication Management and Treatment Adherence Counseling; and Psychoeducation-Support Groups. These actions will provide sustainable revenue and build provider capacity to deliver harm reduction services and hepatitis C treatment.
Expanding Syringe Exchange Access
Recognizing the significant impact syringe services have had in curtailing both HIV and HCV, increased access to syringes is essential to eliminate HCV. The Department of Health will issue regulations that will allow non-profit, religious, and local government entities throughout the state to distribute and collect syringes. Regulations for second-tier syringe services will increase access to syringes, education and support, allowing organizations such as homeless shelters, LGTBQ centers, STD clinics, county health departments, and community-based organizations to help eliminate hepatitis C.
To further expand statewide syringe access, regulations will be issued allowing pharmacies registered in the Expanded Syringe Access Program to promote the availability of hypodermic syringes and needles without a prescription.
Removing Insurance Barriers to Care
The State has identified preauthorization requirements that have made it difficult for people to access care and the medication they need to treat hepatitis C. To address that problem, the state will require managed care organizations to remove such barriers to hepatitis C treatment.
First, the state will require managed care organizations to extend the duration of the prior authorization period to six months in order to give patients the ability to access care more easily. Prior authorization should never result in a disruption of treatment.
Second, the state will ensure that managed care organizations eliminate requirements that patients undergo viral load testing in order to continue receiving their hepatitis C medication. No test should impede continuity of hepatitis C treatment.
Finally, the state will require all managed care organizations to reimburse healthcare providers that use telehealth – or videoconferencing – services in treating hepatitis C patients.
Multimedia Awareness Campaign
The Department of Health will launch a HCV Public Awareness campaign composed of a general campaign to reach all New Yorkers and a targeted message that is aimed at populations with the highest prevalence or risk to contract Hepatitis C.
Commissioner of Health Dr. Howard Zucker said, “As a physician, I have seen firsthand the harmful effects Hepatitis C can have, and as the number of cases continues to increase across the state, it is clear we need to address this problem head on. Governor Cuomo’s commitment to ending the AIDS epidemic is well documented, and I look forward to working to end the Hepatitis C epidemic as well.”
Building on Ongoing Ending the Epidemic Efforts
The announcements follow the release of the Ending the Epidemic 2018 Progress Report, which highlights New York’s nation-leading blueprint to tackle the AIDS epidemic which is on track to bend the curve and reduce the number of new HIV infections below the number of HIV-related deaths by the end of 2020, even while achieving zero AIDS mortality. As part of the Governor’s groundbreaking blueprint, the state has aggressively worked to identify persons with HIV who remain undiagnosed and link them to care; link and retain New Yorkers diagnosed with HIV in treatment to maximize HIV virus suppression so they remain healthy and prevent further transmission; and ensure access to Pre-Exposure Prophylaxis.
Under this aggressive approach, New York is making rapid progress. The Ending the Epidemic report details the remarkable advancements the state has made since the blueprint’s launch, including 75 percent of newly diagnosed New Yorkers demonstrating evidence of entry to care within 30 days of HIV-positive diagnosis. In fact, 80 percent of New Yorkers living with HIV showed evidence of receiving some care over the course of the year. Additionally, in 2016, approximately 70 percent of New Yorkers living with diagnosed HIV appeared to be virally suppressed.