Part of a series of posts about common chronic illnesses and what happens when people cannot afford prescription medications to treat them.
Hepatitis C is an infection caused by a virus that attacks the liver and causes inflammation. An estimated 3.5 million Americans are living with hepatitis C, with about half unaware they even have it. Recent advancements in hepatitis C treatments have greatly improved. New medications can lead to a cure in about 90 percent of people. But the prices for such treatments are prohibiting access and that means more people will remain sick and sometimes die. The Centers for Disease Control and Prevention found that in 2014, hepatitis C related deaths reached an all-time high of 19,659, killing more Americans each year than all other infectious diseases combined, including HIV.
Hepatitis C is slow-progressing, taking years or even decades for symptoms to appear, as most individuals are asymptomatic while the virus silently damages a person’s liver. If left untreated, chronic hepatitis C can lead to cirrhosis, liver failure and sometimes liver cancer. Baby boomers, those born between 1945 and 1965 are at the greatest risk. They are five times more likely to have the hepatitis C virus than any other age group, and federal health authorities have urged all baby boomers to get tested.
A breakthrough treatment called Sovaldi (sofosbuvir) was approved by the Food and Drug Administration (FDA) in late 2013. Its high cure rate was applauded and gave hope to millions who have hepatitis C, but the price – $84,000 for a three-month treatment, or $1000/pill – was met with outrage by healthcare providers, activists, and patients. Newer antiviral medications used to treat hepatitis C today, some more expensive than Sovaldi, include Olysio (simeprevir), Harvoni (ledipasvir and sofosbuvir), and Viekira Pak, along with combination drugs Interferon and Ribavirin.
The cost of one full treatment with the newer antiviral medications often reach $100,000 per patient. Some patients might need two courses of treatment. In some cases, these drugs are taken in combination with each other, depending on the strain of the virus and treatment regimen prescribed by the doctor, creating even bigger cost obstacles for insurers and patients.
Having health insurance does not mean that patients with hepatitis C will be able to access needed medications, and for many there will be substantial cost sharing. A recent study by the Kaiser Foundation found that patients with Medicare Part D coverage who took drugs for hepatitis C, multiple sclerosis, rheumatoid arthritis or cancer could pay between $4,000 to $12,000 out-of-pocket in 2016 for one drug alone. Moreover, while new hepatitis C treatments may be on insurance company formularies, the drugs will often require prior authorization before they will be covered, which often they will not. Furthermore, for the 29 million uninsured and living with hepatitis C, access is most assuredly impossible in the United States.
Many people with hepatitis C in the United States are living below poverty level, imprisoned or elderly, which means American taxpayers will shoulder the excessive drug pricing through government-run programs such as Medicaid and Medicare. An estimated 750,000 Americans infected with hepatitis C are enrolled in Medicaid or are in the prison system. An analysis by Express Scripts, the largest pharmacy benefits management company, projects that the potential cost to states to cover the people with Medicaid would be $55.2 billion. Additionally , in the first six months of 2015, Medicare spent nearly $4.6 billion on new hepatitis C drugs, the same as it had spent for all of 2014.
There are serious barriers to accessing life-saving treatments for hepatitis C due to cost. Many insured Americans with hepatitis C do not receive drug coverage unless their infections have progressed to where their health is at greater risk. Healthcare providers have reported that only 59 percent of patients diagnosed with hepatitis C ultimately receive treatment that could prevent cirrhosis, liver failure, or even liver cancer.
At current prices for new hepatitis C medications, an illness that kills more than any other infectious disease, the ramifications of so many going without treatment are a serious public health threat and public policy travesty in the richest country in the world.