Every week, Dr. Michael Poshkus visits the John J. Moran Medium
Security prison in Cranston, R.I., to see patients infected with
Until recently, their only treatment option was a
weekly injection in the stomach for at least a year. It worked less than
half the time and caused debilitating side effects. But everything has
Drug maker AbbVie won FDA approval
Monday for a new hepatitis C treatment that combines several drugs and
can cure the disease in a matter of weeks or a few months. The news caps
a year of medical milestones for the estimated 3.2 million Americans (including 12 to 35 percent of prisoners) who are chronically infected with this viral liver disease. Yet most of the hepatitis C drugs to hit the market this year
cost tens of thousands of dollars. That puts them out of reach for many
inmates and threatens to break prison health care budgets.
Rhode Island’s prisons are grappling with a dilemma. Hundreds of
inmates have hepatitis C. New drugs can cure it. But they’re so
expensive the department of corrections can’t afford them for every
inmate who’s sick.
In this next part of our series “At the Crossroads,” a look at how prison officials decide who gets treated first.
No surprise here: the Philadelphia Transportation Authority is suing
Gilead, maker of the expensive new hepatitis C drugs Sovaldi and
Harvoni, over the cost of those drugs. A course of Sovaldi, not
including drugs you might have to take in combination with it, as some
patients do, costs $84,000. Harvoni, which won FDA approval more
recently, costs $94,000.
not be surprised if we start seeing more suits over the drugs’ pricing,
including patient groups suing insurers over access to the drugs, and
groups with even less leverage when it comes to getting the drugs, like
The drugs are indeed expensive. I’ve reported on that in my series “At the Crossroads,” both in this story about why the drugs represent such a breakthrough for patients but such a conundrum for payers like Medicaid, and in this one about how health economists determine not just whether a treatment costs too much but whether it’s cost effective.
In our ongoing series about hepatitis C, we look now at one of the
hardest hit populations: veterans. Hep C is three times more prevalent
among vets than in the general population. The Veterans Health
Administration has the country’s largest hepatitis C screening and
treatment program in the country.
But that program is struggling to pay
for new treatments – and the rising number of veterans who need them.
My recent story about the high cost of new hepatitis C treatments focused
on the difficulty of deciding who gets these new drugs now and who has
to wait. That’s because, while new drugs like Sovaldi and Harvoni (both
made by Gilead) promise to cure a lot of people, they’re so expensive we
simply couldn’t afford to treat everyone who’s infected right now. I
looked at how Rhode Island’s Medicaid agency is grappling with this
question, by restricting treatment to patients with the most advanced
liver disease, and placing some other requirements on patients, such as
being drug free for at least six months prior to being approved for
All the experts I’ve been speaking with for this
series tell me that Medicaid covers a disproportionate number of people
infected with hepatitis C; it’s a disease, in many ways, of the
disenfranchised. But it’s also been called the disease of a generation,
baby boomers – people born between 1945 and 1965 (and if that’s you, get
tested!). They’ll soon age into Medicare.
Hepatitis C infects an estimated five million Americans, nearly
20-thousand Rhode Islanders among them. And most of them don’t know it.
But many are about to find out. It takes about 20 years for most people
to notice any symptoms from hepatitis C, and it was about that long ago
most people got infected. Now doctors in Rhode Island and throughout the
country are noticing a wave of patients with the kind of advanced liver
disease hepatitis C can cause.
part of our series “At the Crossroads: Hepatitis C On The Rise And The
Fight To Stop It,” we check in on the race to find infections before
it’s too late.