What Does It Mean To Have A Successful Treatment What Is A Sustained Virologic Response
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.
How Is The Test Used
The various hepatitis C tests have different uses:
The HCV antibody test may be performed as part of an acute viral hepatitis panel to determine which of the most common hepatitis viruses is causing your symptoms.
Latest Research On Hep C
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.
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What If I Cannot Afford Treatment
Many affected by hepatitis C dont have insurance and therefore cant absorb the high costs of treatment Others cant afford the co-pays required by insurance companies. In one study, it was estimated that 30% of those infected have no private insurance.3 Another study estimated the rate at 65%.4 For those who cant afford treatment, there are patient assistance programs that offer free or reduced cost hepatitis C treatments for individuals with lower income levels who are uninsured or underinsured that dont meet the qualifications for Medicaid or Medicare.
Many of the pharmaceutical companies that produce these drugs can help you contact a patient advocacy organization, offer reduced treatment programs, or have subsidiaries that can help. For example:
Asegua Therapeutics LLC : Generics of Epclusa and Harvonihttps://www.asegua.com/contact333 Lakeside Drive, Foster City, CA 94404Medical Information/Customer Service: 1-800-445-3235
Gilead Science: Epculusa, Harvoni and Vosevihttps://www.gilead.com/purpose/medication-accessFoster City, CA , 333 Lakeside Drive, Foster City, CA 94404, Phone: +1 650 574 3000, 1-800-GILEAD-5
AbbVie Inc: Mavyret
In addition many states, counties and municipalities have patient advocacy and assistant programs offering a range of services including providing or linking patients to financial support for their treatments.
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Why Is Hepatitis C Treatment So Expensive
Hep C drugs are in high demand, with an estimated 2.4 million people in the United States living with the virus. This contributes to the high cost of medications.
The cost of research and development of the drugs is expensive, too. And since these medications have a high cure rate and there isnt a lot of competition theres little incentive for drug companies to lower the cost.
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Shop Health Insurance Plans
Even though health insurance can be expensive, your monthly premium through an employer might be considerably less than the cost of treating hep C without it. If thats not an option, you can research coverage options on the U.S. Health Insurance Marketplace during open enrollment periods.
Keep in mind, though, even with private or individual health insurance, your provider might not cover the cost of hep C treatment until youre very sick, and only if you dont use drugs or alcohol. Be sure to find out all you can about your coverage before applying.
New Screening Guidelines Have An Impact
In a study of the effects of the new CDC testing guidelines, Barocas, Wang, White, et al. found an immediate and sustained impact of hepatitis C testing guidelines on clinical practice. They analyzed hepatitis C screening rates in 2.8 million commercially insured adults before and after the recommendations, using a cohort born after 1965 as a comparison group. As shown below, they found a 49% increase in screening rates among the birth cohort after the release of the recommendations, but no increase among the comparison cohort.
Rodriguez, Rubenstein, Linas, et al. confirmed the effects of the CDC and USPSTF screening recommendations in an observational study of 665,000 adults visiting Kaiser Permanente clinics between 2003 and 2014. They documented a steady increase in screening over time, with a noticeable jump in screening after the USPSTF recommendations. As shown below, HCV screening jumped 29% from 2013-2014, compared to 4% from 2012-2013.
Adjusting for other factors, the authors found that screening in the birth cohort more than doubled, which represented a 20% greater increase than screening in other age groups. The authors point out that insurance coverage for screening and the availability of effective treatment after the USPSTF recommendation may have led to a greater increase in screening than screening guidelines alone.
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Q: Can Hepatitis C Be Prevented
A: Hepatitis C could be avoided by taking precautions just. Although vaccines for hepatitis A and B can be found, theres not any vaccine available to shield against hepatitis C. Since the principal source of transmission of HCV is infected blood, the illness can be prevented from spreading by preventing the contact with contaminated blood, e.g. consumption of needles, private things such as razor and nail clipper ought to be prevented.
Your Insurance Company Could Say No
Some insurance companies try to combat the high cost of hepatitis C drugs by rejecting coverage for them. More than one-third of people were denied coverage for these drugs by their insurance company, according to a 2018 study in Open Forum Infectious Diseases. Private insurance companies rejected more claims for these drugs over 52 percent than Medicare or Medicaid.
Medicare and Medicaid are more likely to approve hepatitis C drug coverage. But with Medicaid, you might have to meet certain requirements to receive these drugs, such as:
- getting a referral from a specialist
- having signs of liver scarring
- showing proof that you have stopped using alcohol or illicit drugs, if this is a problem
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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 â including over-the-counter medicines, vitamins, herbs, and supplements
- Complete the entire course of medication
Hepatitis C Treatment: Medicare Coverage Of Liver Transplants
In severe cases, your doctor might recommend a liver transplant might be recommended for hepatitis C patients. In fact, according to the Centers for Disease Control, hepatitis C is the most common reason for liver transplant surgery in the United States.
If this is medically necessary for your hep C treatment, Medicare Part A generally covers the hospital portion of the procedure under certain conditions at an approved, Medicare-certified facility, while Medicare Part B may cover any doctor services needed as part of your liver transplant.
Youll typically be responsible for paying 20% of the Medicare-approved amount for doctor services for hepatitis C treatment, and the Part B deductible applies. Medicare generally covers your lab tests as part of your hepatitis C treatment. You may need to pay various out-of-pocket costs- for example, for doctor visits and transplant facility charges.
I hope you now have a better understanding of how Medicare covers hepatitis C treatment and what your options may be. Are you looking for more coverage to help with your hepatitis C treatment or management? I can help you find a or a Medicare Advantage Prescription Drug Plan that may fit your health needs and your budget.
You can click one of the links below to set up a time to talk by phone or get a personalized email with plan information. Compare the plan options in your location by clicking the Compare Plans or Find Plans buttons on this page.
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Home Screening Tests For Hepatitis C
At-home screening tests provide privacy if you prefer not to go to a doctor or clinic for testing. These tests typically look for antibodies to hepatitis C, but they may not always test for active viral infection. Make sure you know what type of test youll be taking before you buy.
Many at-home tests have close to or the same reliability as blood tests received by a medical professional.
If youve recently been exposed to hepatitis C, wait several weeks before testing at home.
Whats The Optimal Hcv Screening Strategy
Using a simulation model, Barocas, Tasillo, Eftekhari Yazdi, et al. compared the clinical costs, outcomes, and cost-effectiveness of four HCV testing strategies: the existing one one-time testing for adults aged 40 or higher, 30 or higher, or 18 or higher. All strategies included targeted testing of people at higher risk, such as those who inject drugs. As shown below, expanded age-based strategies increased identification and lifetime cure rates.
Figure 3. HCV continuum of care over a lifetime, by strategy
The authors estimate that the existing strategy would identify 71% of all HCV-infected people, and 44% of them would be cured over a lifetime. Compared to existing screening, a strategy of age 18 or older would result in 256,000 additional people identified, 28,000 additional cures, and 4,400 fewer cases of hepatocellular liver cancer over the lifetime of this age group. For people born outside the baby boomer cohort, case detection rates would increase from 74% to 85%, and cure rates would increase from 49% to 61%. Overall, this would represent a 21% reduction in liver-attributable mortality, and an increase in life expectancy from 67.2 to 68.2 years among the affected population.
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Some Affected Populations Lack ‘political Voice’
Dr. Jordan Feld, a hepatologist at the Toronto Centre for Liver Disease at the University Health Network and the specialist who treated Lecour, said hepatitis C is “a huge public health problem right here in Canada” and it’s “disappointing” to hear that the virus may not be eliminated in the next 13 years a goal he believes is achievable.
“We now have the tools. We can diagnose this simply, we have treatment that works in almost everybody,” he said. “We could eliminate hepatitis C from Canada.”
Although the price of the drugs to cure hepatitis C are too high, Feld said, it has “come down dramatically” in Canada from what they were.
The Cure For Hepatitis C Is Upon Us But At A Costly Penny
This article was published more than 8 years ago. Some information may no longer be current.
The new anti-hepatitis C drug Sovaldi is made by Gilead Sciences Inc.
There is a revolution coming to the treatment of hepatitis C. But a big fat asterisk is required with that assertion.
In the coming months, a number of drugs are going to be rolled out that can essentially “cure” hepatitis C. The most talked-about, by far, is Sovaldi , a product of Gilead Sciences Inc. It is currently sold as a single pill. In the future, a pill containing sofosbuvir and, a second drug, ledipasvir, will become available.
The clinical trials involving this drug have produced some eye-popping results. They show that treating people infected with HCV, the virus that causes hepatitis C, with a single pill a day for as little as eight weeks can reduce the virus levels in their bodies to undetectable levels. This is referred to as a “functional cure” or remission, because relapse is possible. But the relapse rate is only 5 per cent after eight weeks, and it drops to 2 per cent if the regime is followed for 12 weeks, and to 0.2 per cent after 24 weeks of treatment.
Although other companies have produced similarly effective regimes, they have generated a lot less media attention because they are using cocktails of drugs. For example, AbbVie has produced a three-drug combo ritonavir, ombitasvir and dasabuvir that has similar “cure” rates in the 95- to 99-per-cent range.
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Hep C Treatment Yes But Not For Everyone
Another problem is, the miraculous Harvoni® doesnt work its magic for all the genotypes. Until recently, patients with genotypes 2 and 3 had to use Sovaldi® in combination with either interferon or Daklinza®.
On the bright side, later this year FDA approved a new drug for hepatitis C. Epclusa® can be successfully used for hepatitis C treatment regardless of genotype and when it comes to genotypes 2 and 3, its efficiency is slightly superior compared to the previously existing regimens. It is cheaper, too: starting at only $71,328 per three bottles.
Whats the bad news? Medicare wouldnt pay for it.
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The Cost Of Hepatitis C Treatment
Though all of these drugs have been hailed as major medical breakthroughs, much of the discussion around them has focused on their exorbitant price tags. When sofosbuvir was released, it made news because a 12-week round of treatment came in at a total of $84,000. Harvoni cost even more — $94,500 for a 12-week course, though some patients may be cured after only eight weeks, or $63,000. Gilead’s newer offering, Epclusa, goes for just over $74,000. The gamechanger in the market may be Mavyret, which costs $26,500 for treatment. As of January 2019, there are also of some of these drugs available at lower prices.
There have been many arguments about whether these prices may be justified if they actually do provide a permanent cure. Patients with hep C who are not cured often go on to need far more expensive care. One study estimated that yearly care for an HCV patient without liver damage is approximately $5,800. This goes up to over $27,000 each year for an HCV patient with decompensated cirrhosis of the liver, over $43,000 a year for an HCV patient with liver cancer, and over $93,000 a year for a patient who has had a liver transplant.
In the long term, it is likely cheaper for insurers to pay for treatment with a DAA than to wait and pay for ongoing care once the patient gets sicker. Moreover, curing those who have been diagnosed would also prevent the virus from spreading further, which could in turn keep future costs down.
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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.
Hep C Treatment Refused To All But Critical Patients
In 2014 in California, for example, 94% of those who requested hepatitis C drugs through Medi-Cal were denied coverage. Meanwhile, in the same fiscal year the state has paid $58 million to treat prisoners with advanced stages of hepatitis C.
The situation in California is not unique. Of the 42 states where Medicaid actually reimbursed sofosbuvir, the active substance of Sovaldi® and Harvoni®, 74% limited treatment access only to persons with advanced fibrosis or cirrhosis .
The vast majority of states include drug or alcohol use in the eligibility criteria, requiring either a period of abstinence or urine screening two third of states impose restrictions based on prescriber type.
Medicaid reimbursement criteria for sofosbuvir based on liver fibrosis stage Annals of Internal Medicine
Among the commonly recommended treatment regimes for hepatitis C are Sovaldi®, Harvoni®, Epclusa® and Viekira Pak®.
These limitations dont match the latest recommendations for hepatitis C treatment. In fact, initiating therapy in patients who did not yet develop severe fibrosis augments treatment benefits, while treatment delay decreases it.
Treatment is recommended for all patients with chronic HCV infection, except those with short life expectancies that cannot be remediated by treating HCV, by transplantation, or by other directed therapy. HCV Guidelines
Simply put, the insurers are caught between Big Pharmas sky-high prices and HCV advocates who say that rationing care is illegal.
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