Thursday, September 29, 2022

Cost Of Medication For Hepatitis C

Latest Research On Hep C

Gilead slashing prices of top-selling hepatitis C drugs

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While the new treatments are impressive, researchers continue to try to find a vaccine. In 2019, a preventive hep C vaccine was put into clinical trials, but it wasnt effective. Womp womp.

Still, theres hope! Hepatitis C wasnt even discovered until 1989, and in only about 25 years researchers were able to develop medications that could cure the disease. Hopefully vaccine research will continue to evolve so we can get rid of this disease.

Healthcongress May Be To Blame For High Drug Prices

People can be cured of hepatitis C but they are not immune from getting it again. Some states fear that people who had been infected through risky behavior, such as injecting drugs, might get re-infected, and theyd end up treating the same patients over and over.

That is a shortsighted policy, argued Alyson Harty, clinical nurse manager for Mt. Sinais liver institute.

Even if a patient doesnt need a transplant, the cost of cirrhosis care for a patient thats in and out of the hospital over even a year is way more than the cost of treatment, she said.

And the cure rate is high. In my office, more than 93 percent of patients treated for hepatitis are cured, Bordon said.

Characteristics Of Base Case Population

We simulated a total of 150 unique HCV-patient profiles based on five age categories , three HCV genotypes that are prevalent in Japan , patients sex and METAVIR fibrosis score . The distributions of these HCV-infected patient profiles were estimated based on available data . The model did not include patients with HIV or hepatitis B virus co-infection as well as special groups at higher risk of HCV reinfection, such as those with hemodialysis, thalassemia, haemophilia or injection drug use. All patients were considered treatment-naïve because the current percentage of treatment-experienced patients in Japan is small.

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We Have A Cure For Hepatitis C Why Are Rates So High

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We have had the ability to cure many people of hepatitis C — a common viral infection of the liver — since 2011. These new drugs are effective at curing most strains of the virus and have far fewer side effects than earlier generations of treatment. Despite these major scientific advances, however, hepatitis C rates remain high, particularly among those who are also living with HIV, as well as among people in prison and people using drugs, particularly drugs taken by injection.

Our lack of progress toward eliminating hepatitis lies in a poor screening and surveillance system, the continuing opioid epidemic, and the high cost of the cures — which has led many insurers, most notably Medicaid, to limit treatment to those who are already suffering some of the long-term consequences of this infection.

What Does It Mean To Have A Successful Treatment What Is A Sustained Virologic Response

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In an untreated state, the hepatitis C virus infects the cells of the liver and then continuously lives there, making copies of itself that circulate in the bloodstream. Antiviral medications can destroy the ability of the virus to reproduce, so the amount of virus in the bloodstream then decreases. The amount of virus in the blood is measured by aviral load.

Treatment is successful when the viral load drops toundetectablelevels, which means the virus cannot be detected in the bloodstream at all. The viral load becomes undetectable during treatment and remains undetected after treatment has ended. If there is still no detectable virus in the blood 12 weeks after the end of the treatment, the treatment was successful. This is called a Sustained Virologic Response .

A patient who has achieved an SVR is considered to be cured of the hepatitis C virus.

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The Real Cost Of Hepatitis C Medications

New hepatitis C drugs are extremely effective, but their price tags are a jaw-dropper. A three-month treatment course can easily cost $70,000-$100,000. Its pretty obvious that at this price the vast majority of uninsured patients cant afford the treatment. What is little known though, is that the situation is hardly better for those covered by state insurance programs.

Who Can Help Me

If youre concerned about paying for HCV medications, remember that you arent alone as you seek treatment. There are people and organizations that can help you, including the following:

  • Your doctor. They can help you by ordering and documenting the tests youll need so you can qualify to get your medications, especially if youre working with a liver or infection specialist.
  • Most drug manufacturers. There are patient assistance programs that offer free or reduced-cost medications for people who meet their criteria.
  • Patient advocacy groups. These groups provide assistance with all aspects of HCV treatment. For instance, if your insurer denies treatment, you can appeal the decision with help from one of these groups. Your doctor can also help in this situation.

Drug companies and patient advocacy groups are a great place to start when looking for help paying for HCV medications. Heres a list to get you started.

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The Patient Advocate Foundation

This organization provides copay relief and a directory of national and local resources that can offset some of the financial burden of medical expenses.

Whatever the cost, the benefit to the person to eradicate hepatitis C today and not deal with complications is immense, says Joseph Galati, MD, medical director for the center of liver disease and transplantation at Houston Methodist Hospital.

The average person may not appreciate the savings from preventing somebody from getting liver cancer or a liver transplant or the disability associated with chronic hepatitis C, says Dr. Galati. Whatever the cost for treatment is, its a drop in the bucket when you look years down the line as far as the potential cost of living with hepatitis C.

Q: Do Any Patients Pay Those Total Costs Out Of Pocket Or Does Insurance Cover It

Cost-Effectiveness of Access Expansion to Treatment of Hepatitis C Virus…

Insurance plans may cover the costs, but also may require copays from patients. “We have had approvals for both, with some copays from patients,” Carey says. Both drugmakers say they have programs to provide assistance either to reduce the out-of-pocket costs or to provide the drugs at no charge.

Even so, the assistance programs for the new hepatitis C drugs are not, so far, ”as mature, friendly or helpful” as similar programs for other drugs, Carey says.

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Treatment Regimens And Efficacy

We simulated two strategies: no treatment and treatment with available DAAs. The DAA treatment regimens used were determined by individual patients HCV genotype and METAVIR fibrosis stage. The treatment efficacy in various scenarios was based on the SVR rate reported in clinical trials of DAAs, and uncertainty in SVR rates was incorporated in sensitivity analysis. Regimen-specific treatment discontinuation rates were also incorporated in the model. Data about the treatment regimens were obtained from recent clinical trials of DAAs in treatment-naïve patients,,, and are provided in Supplementary Table .

What Can People Do To Help The Medications Work Best

  • Take the medications every day
  • Stay in touch with pharmacy to be sure that all refills are ready on time
  • Take the medications exactly as prescribed
  • Do not skip doses
  • Get all blood tests done on time
  • Go to all visits with providers as recommended
  • Tell the provider about all other medications that are being taken – including over-the-counter medicines, vitamins, herbs, and supplements
  • Complete the entire course of medication

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What Do These Findings Mean

  • Paying for sofosbuvir and ledipasvir/sofosbuvir in national health systems would consume large proportions of their total pharmaceutical budget. The potential total cost of treatment presents a financial and ethical dilemma for payers and physicians. Some national health systems have therefore restricted access to these medicines to small groups of patients, despite the fact that almost all patients with chronic hepatitis C infection are likely to benefit from treatment with these medicines.
  • Our analysis is limited by the accuracy of the price information that was accessible, which may be inaccurate because of confidentiality agreements between manufacturers and purchasers. The estimates of the numbers of people infected with hepatitis C are also uncertain. Also, we have considered only the costs of the medicines themselves and not the costs of other parts of the treatment for hepatitis C, so we have most likely underestimated the true total cost.
  • If countries are to try to pay for treating all patients with hepatitis C, governments and industry stakeholders will need to jointly develop and implement fairer pricing frameworks that lead to lower and more affordable prices.

Citation: Iyengar S, Tay-Teo K, Vogler S, Beyer P, Wiktor S, de Joncheere K, et al. Prices, Costs, and Affordability of New Medicines for Hepatitis C in 30 Countries: An Economic Analysis. PLoS Med 13: e1002032. https://doi.org/10.1371/journal.pmed.1002032

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Often, patients dont take hepatitis drugs as they should. Drug users may sell the valuable pills, or patients may forget a few doses, allowing the virus to mutate. Tia did not fall into either category.

Bordon now thinks it was likely one of the many natural supplements that Tia had been taking interfered with the drugs action, making it less effective and allowing virus to survive in her body.

Supplements can screw up hepatitis C treatments, said Dr. Douglas Dieterich, director of the Institute of Liver Medicine at the Icahn School of Medicine at Mount Sinai in New York.

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Q: What About All The Savings In Terms Of Fewer People Infected And Fewer Treatments For Chronic Infection Complications

From a public health standpoint, reducing the number of infected people is desirable, Masur says. “The more sick people in the population, the higher the hazard to public health,” Masur says, since an infected person can spread the virus.

The higher cure rate with the newer oral drugs offers multiple benefits, Carey says. “It runs the gamut, from saving people from the emotional turmoil of hepatitis C to reducing the likelihood of developing cirrhosis, dying of liver failure, or getting liver cancer.”

But, he says, the time it would take for the treatment costs to be offset by the savings in other treatments will probably be lengthy. In one scenario evaluated by the nonprofit Institute for Clinical & Economic Review, analysts say only two-thirds of initial drug costs would be offset by medical savings at the 20-year mark.

Drug Cost And Reimbursement

Many organizations are involved with hepatitis C drug distribution and each can impact costs as well as decisions about which regimens are reimbursed . The roles these organizations have in determining the actual price paid for drugs and who has access to treatment include the following:

Except for mandated rebates, negotiated drug prices are considered confidential business contracts. Therefore, there is almost no transparency regarding the actual prices paid for hepatitis C drugs . However, the average negotiated discount of 22% in 2014 increased to 46% less than the WAC in 2015, implying that many payers are paying well below the WAC for HCV medications .

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Are There Ways To Cure Hepatitis C Other Than With Medications

Patients sometimes ask whether there are ways to treat hepatitis C other than taking medicines. Currently, there are no vaccines to prevent hepatitis C. Once a person is infected, the only way to treat it is with prescribed antiviral medications.

Some patients worry that having hepatitis C means they will need a liver transplant. Only a very small fraction of people with hepatitis C require a liver transplant. By far, most people with hepatitis C never need a liver transplant. A transplant is performedonlywhen damage to the liver is extremely advanced and the liver is unable to perform its basic functions. A transplant provides a new working liver, but a transplant does not get rid of the hepatitis C virus in the patient. Patients with a liver transplant still need antiviral medication to cure their virus.

Prices Costs And Affordability Of New Medicines For Hepatitis C In 30 Countries: An Economic Analysis

Hepatitis C drugs costing Pennsylvania taxpayers millions
  • Affiliation World Health Organization, Geneva, Switzerland

  • Affiliation WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Health Economics Department, Gesundheit Österreich GmbH, Vienna, Austria

  • Affiliation World Health Organization, Geneva, Switzerland

  • Affiliation World Health Organization, Geneva, Switzerland

  • Affiliation World Health Organization, Geneva, Switzerland

  • Affiliation World Health Organization, Geneva, Switzerland

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Q: We Hear About A $1000

The cost for Sovaldi varies based on the exact use, says Michele Rest, spokeswoman for Gilead, which makes the drug. When used with the hepatitis C drug ribavirin, a common combination, a 12-week course costs about $84,000 wholesale, or $1,000 a day, she says.

A 3-month course of Olysio , also used with other medications, is about $66,000 wholesale, or about $733 a day, says Craig Stoltz, a Janssen spokesman.

Faq: The High Cost Of Hepatitis C Drugs

April 14, 2014 — Last week, the World Health Organization strongly endorsed two new oral drugs that fight hepatitis C, a liver-damaging virus. The WHO recommended that all 150 million people infected worldwide be assessed for these drug treatments.

With that endorsement, though, came concern from WHO officials about the high price of these new medicines, one of which costs $1,000 per pill. Some doctors and insurers — and now an editorial in the New England Journal of Medicine — are voicing the same concern. A large U.S. pharmacy benefits manager is threatening a boycott if costs don’t come down.

Meanwhile, new drugs in the pipeline have a success rate that rivals the two main players.

Hepatitis C is spread by an infected person’s blood, such as by sharing needles or drug equipment, sexual contact, or, in years past, by transfusions and organ transplants. If infection becomes chronic, it can progress to liver failure, liver cancer, or the need for a transplant. In the U.S., about 3 million people are infected, but many are unaware of it.

WebMD asked experts and the drugmakers to address the most frequently asked questions about these two pricey ”game-changers” and got some predictions about future treatment costs.

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Cure At A Gigantic Price

As a baby boomer, Tia was at risk. The Centers for Disease Control and Prevention recommends that everyone born between 1945 and 1965 get tested for the virus, which can be spread by poorly sterilized medical and dental tools, needles, blood products, tattoos, shared razors and, rarely, through sex.

Half of the 3.5 million people who have hepatitis C dont even know they have it, the American Association for the Study of Liver Diseases estimates.

The virus causes cirrhosis and liver cancer. Hepatitis C once was incurable and it killed or contributed to the deaths of more than 19,000 people in 2015, the CDC says. Antivirals helped, but not a whole lot.

Newly developed direct-acting antiviral drugs can cure up to 95 percent of patients. But the cure comes at a gigantic price. These drugs are notoriously expensive.

Gilead priced its first new hepatitis C drug, sofosbuvir, at $1,000 per pill, or $84,000 for a three-month course of treatment. Its first combination pill, Harvoni, cost $94,500.

But doctors, the CDC and other organizations said the price tag was worth it and cheaper in the end than providing liver transplants and other treatments for people dying of cirrhosis or liver cancer.

While it sounds like a simple choice, Tia has found things are much more complicated in real life. Right away, the private insurance company that provides Tias Medicaid coverage balked at paying for the priciest drugs.

We went for Harvoni, Tia said. They said no.

Model Structure And Assumptions

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A decision-analytic Markov model was developed based on the results of previous studies. Fifteen exclusive health states were addressed, as shown in : METAVIR liver fibrosis states , liver fibrosis states achieving SVR , decompensated cirrhosis , hepatocellular carcinoma , liver transplantation , post liver transplantation and death. The model comprised the stages of treatment and disease progression. Patients received different treatment regimens when entering the model. Subsequent stages were determined according to their initial health state and treatment outcome. Annual cycles and lifetime horizon were adopted. The key assumptions of the study were as follows: spontaneous elimination of the virus was not considered patients received treatment only once, without considering further treatment after treatment failure or recurrence treatment compliance was 100% patients in F0F3 states would no longer experience disease progression after achieving SVR, while patients in F4 state with SVR and all patients without SVR would enter a stage of disease progression.

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Why Should People Take Antiviral Medications For Hepatitis C

The purpose of taking antiviral medications for hepatitis C is to:

  • remove all the hepatitis C virus from your body permanently
  • stop or slow down the damage to your liver
  • reduce the risk of developing cirrhosis
  • reduce the risk of developing liver cancer
  • reduce the risk of liver failure and the need for a liver transplant

Hepatitis C Drugs Are Pricey

Antiviral drugs for hepatitis C are very effective, but they come at a steep cost. Just one Sovaldi pill costs $1,000. A full 12-week course of treatment with this drug costs $84,000.

The price of other hepatitis C drugs is also high:

  • Harvoni costs $94,500 for a 12-week treatment
  • Mavyret costs $39,600 for a 12-week treatment
  • Zepatier costs $54,600 for a 12-week treatment
  • Technivie costs $76,653 for a 12-week treatment

Hepatitis C drugs are expensive due to the large demand for them, and the high cost of bringing them to market. Developing a new drug, testing it in clinical trials, and marketing it can run pharmaceutical companies nearly $900 million.

Another factor adding to the high cost is the lack of a national health care system to negotiate medication costs on behalf of consumers. Theres also little competition from other drug companies. As a result, hepatitis C drug manufacturers can essentially charge whatever they want.

Prices could drop in the future as more pharmaceutical companies get into the hepatitis C drug market. The introduction of generic versions of these drugs should help drive costs down.

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