The price of treatment has dropped for everyone except the most vulnerable patients.
In an exciting development, Missouri Medicaid (MO HealthNet) recently lifted restrictions on treatment of chronic hepatitis C, which will enable many low-income Missourians to access curative treatment.
Hepatitis C can lead to severe liver disease, liver cancer and death, killing thousands of Americans each year. Hepatitis C is a blood-borne virus that can be transmitted through blood transfusion, occasionally through sexual contact, sharing needles, or in some cases from mothers to children at the time of childbirth. Others at increased risk of infection include health care workers and first responders who may encounter infected blood from needle-sticks.
The Centers for Disease Control and Prevention have indicated that nearly 19,000 people will die each year in the U.S. due to hepatitis C and related liver disease. Even before the disease progresses to advanced stages, hepatitis C can cause fatigue, joint pain, depression, skin rashes and sore muscles. The disease can also lead to additional complications, including lymphatic cancers (particularly non-Hodgkin’s lymphoma), kidney damage and immune-related diseases. Moreover, chronic liver disease due to hepatitis C is one of the leading causes of death for black Americans between the ages of 45 and 64.
Rhode Island blocks life-saving treatment for people living with Hepatitis C. The state Department of Human Services applies unnecessary restrictions on Medicaid patients suffering from this disease. These restrictions not only contradict medical and legal advice, but they impair Rhode Island’s ability to address a public health crisis.
Rhode Island’s restrictions form significant barriers to care that are medically unadvisable. Hepatitis C virus (HCV) is the deadliest infectious disease in the United States. It causes liver inflammation, which can lead to irreparable scarring and failure. Early treatment is more effective and prevents cirrhosis and liver cancer. Restrictions, such as waiting periods, are not necessary for the medication’s success. In fact, they delay care and put Rhode Islanders at risk.
Not only are the restrictions medically unnecessary, they violate federal law. State Medicaid agencies cannot set policies that produce unreasonable restrictions to medically necessary care. Despite this legal obligation, Rhode Island officials delay access to the HCV cure and force residents to suffer years of liver deterioration.
Note: Way to go Vermont and those who fought hard to remove the restrictions!
Office of the Health Care Advocate and Coalition Continue Advocacy to Ensure Treatment for All
At its meeting on October 24, Vermont Medicaid’s Drug Utilization Review Board (DURB) voted to lift the liver damage restriction that currently prevents many Vermont Medicaid patients with hepatitis C from accessing life-saving treatment. Because of this change many more Vermonters on Medicaid who have the life-threatening disease will gain access to curative treatment. Vermont Legal Aid’s Office of the Health Care Advocate and a coalition of organizations have been advocating for this change since 2015. The coalition sent a letter to the DURB earlier this month asking the Board to remove all remaining restrictions on hepatitis C medications.
On Tuesday, the DURB voted to stop requiring people to wait until they have significant liver damage to be treated. Since February, Vermont Medicaid has required a fibrosis score of F2 (moderate liver damage) or higher to access treatment. Prior to February Medicaid required a fibrosis score of F3 (severe liver damage) or F4 (cirrhosis) to access treatment. Patients will still need to see a specialist in order to get treatment.
“We are very pleased that the DURB voted to lift the liver damage restriction on hepatitis C treatment, as is required by federal Medicaid law. Treatment of every patient with hepatitis C is the standard of care. There is no medical justification for denying treatment because the patient’s liver isn’t damaged enough,” said Mike Fisher, Vermont’s Chief Health Care Advocate.
Starting today, the North Carolina Medicaid program will pay for medicines to treat hepatitis C for patients no matter how sick they are. In the past, the state wouldn’t pay for the expensive drugs unless the patient had stage two liver damage.
Thirty-five-year-old Ginger Parker doesn’t know how long she’s had hepatitis C. She used heroin for nine years, so she’s pretty sure she knows how she got the viral infection that attacks the liver.
“We all shared needles,” she said. “I don’t know exactly how many. It was just the thing that you did. ”
The conundrum of hepatitis C is well known. The virus kills more than 20,000 Americans each year, more, according to Centers for Disease Control and Prevention, than the other 60 infectious causes of death combined. A cure is in hand, but is out of reach for many because it costs tens of thousands of dollars per patient. The problem is most acute in state Medicaid programs and prisons, where 700,000 people need treatment but only 20,000 a year will get it. The price controls some have asked for would make treatment affordable, but would also be likely to chill innovation in pharmaceutical companies, the very innovation that benefits society by producing such remarkable drugs.
A recent consensus committee of the National Academies of Sciences, Engineering, and Medicine proposed a novel strategy to improve access to hepatitis C medicines. Their report recommends that the firms producing the hepatitis C treatments compete to license their patent to the federal government for use in neglected patients, such as Medicaid beneficiaries and prisoners. Such a deal would protect the innovator companies’ market share in the lucrative private markets, while allowing the government to save billions of taxpayer dollars and reach more poor patients.
How Would The Deal Work?
Every year roughly 20,000 Medicaid beneficiaries receive hepatitis C treatment. After the mandatory Medicaid discount, these medicines cost about $40,000 per patient. Thus, under the status quo over the next 12 years about 240,000 Medicaid patients will receive treatment, generating roughly $10 billion in revenues for manufacturers. Since these revenues are earned over a 12 year period their worth in today’s dollars is roughly $6.5 billion. Pharmaceutical firms should be indifferent between being paid $6.5 billion today rather than $10 billion over a 12-year period.
Preliminary analysis from Hepatitis C: The State of Medicaid Access – announced Monday, November 14, 2016 at The Liver Meeting® in Boston – shows some improvements in both state Medicaid program transparency and access since 2014, yet also demonstrates that most states continue to impose discriminatory restrictions which contradict guidance from the Centers for Medicare & Medicaid Services (CMS), as well as guidance from AASLD and the Infectious Disease Society of America. Also concerning is that nearly half of states may not be making all restrictions publicly available.
To read the preliminary report and a powerpoint presentation, visit the National Viral Hepatitis Roundtable Website – here.
Stat, the online health news site, deserves credit for the grim picture it painted of health care dysfunction in the nation’s heartland. Kentucky has been ravaged not only by opioid drug abuse, including record numbers of overdose deaths, it also is struggling with a stark, related rise in diseases. In particular, cases of Hepatitis C have skyrocketed by 364 percent in Kentucky and surrounding states. Infections are growing most among young, rural whites, and to the growing concern of public health officials, Kentucky is recording increasing numbers of cases in which pregnant moms are infecting their babies.
Hepatitis C, a viral infection that damages the liver and is a factor in 19,000 Americans’ death annually, can lurk in the body for long periods before becoming deadly. As many as 4 million Americans may carry it and not know it until their liver damage becomes severe. The virus (depicted in the illustration above) spreads among addicts of pain-killing medications because they too often progress from prescription pill-popping to shooting up other increasingly powerful opioids like fentanyl and heroin.