What Are The Names Of The Medications For Treating Hepatitis C
Since 2014, multiple different antiviral treatments for hepatitis C have been developed. With the many options now available, often there is more than one good choice for a patient. Some of the treatments are recommended as first-line options, some are second-line options, and others are used less commonly in light of all the available choices.
Second line hepatitis C medications:
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The state is also facing a shortage of doctors who both prescribe hepatitis C drugs and treat Medicaid patients, making it very difficult for people living in rural areas to access care. In certain areas of the country, like Natchitoches Parish on the western border of the state, the nearest clinic is either 50 miles south in Alexandria or 70 miles north in Shreveport, according to the states own database of providers. Patients living in the parishes on the eastern border, like Madison, likewise would have to travel nearly 50 miles to the city of Monroe to see a doctor.
I see patients from hours away sometimes that are driving here to find someone to treat hepatitis C, Richey said.
Louisiana also had plans to set up a training program, dubbed HCV Champions, to get doctors familiar with treating hepatitis C. It set a goal of having one hepatitis C treatment advocate in each of the states nine public health regions. But the state doesn’t appear to have reached that modest goal either.
Experts STAT spoke to emphasized that Louisiana’s slowing progress could be explained by the fact that the state had a backlog of people awaiting treatment in the early rollout, but now, its harder to find people to treat.
Hcv Treatment Provides Good Value
Despite its cost, HCV treatment provides good value for the money, as expressed in terms of cost-effectiveness. In a recent review, Linas and Nolen note that most studies in the past five years find that HCV treatment falls within the generally accepted value of $100,000 per quality-adjusted life year . They note that these studies do not reflect price decreases that have occurred in the past 1-2 yearsbut the substantial cost burden remains. A critical question is not whether to treat patients with HCV, but when, because of the significant lag time between infection and disease. Facing costs that could overwhelm fixed budgets, many payers have restricted treatments to those with advanced disease or those who are alcohol- or drug-free.
There is some evidence that public payers are relaxing their eligibility restrictions for hepatitis C treatment. Kapadia, Jeng, Schackman, and Bao looked at Medicaid drug utilization data from 2014 to 2016, and found that states that loosened their restrictions had a more rapid increase in prescriptions of direct-acting antivirals than states maintaining their restrictions. The 31 states that implemented Medicaid expansion under the Affordable Care Act saw much more of an increase in utilization than states that did not.
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Edema Symptoms Lead To Diagnosis
The Baltimore resident found out he had the disease in 2018 after his feet swelled up. My feet were so bad, I had to take the shoestrings out of my shoes so I could walk, he says.
I couldnt believe I tested positive, says Pannell, 64. I was mad, but I figured that I probably got the disease from sharing needles because I was an addict at one time. Today, Im going on 17 years clean.
After completing eight weeks of antivirals, Pannell was retested. He still had hepatitis C. I was frustrated and discouraged that it didnt work, says Pannell, but my care provider said lets try it again.
After a second round of therapy, Pannell was cured.
Medicare Coverage Allows For Treatment Success
Sherilyn C. Brinkley, a certified registered nurse practitioner and a program manager at the Johns Hopkins Viral Hepatitis Center in Baltimore, advised Pannell on his care. She says he was fortunate to receive Medicare coverage.
What came with this incredibly easy, short, extraordinarily effective regimen was a really high cost, Brinkley says. Ever since then, weve been able to cure thousands of patients just here in Baltimore. But weve had to really struggle with access to drugs along the way. Many are still not able to get treated because of the cost, and thats a frustrating element of this whole process.
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What Are The New Findings
- In addition to the construction of compartmental agesex model along hepatitis C disease progression, the results of this study provide new evidence that the expansion of DAAs coverage by national health insurance and scale-up of hepatitis C screening and treatment with DAAs are cost-effective.
- This study provides a comprehensive assessment of economic and health impacts from scaling up hepatitis C screening and treatment with DAAs in one high-income country.
Hepatitis C Drug Cost Lower In Us Than Other Countries
Despite widespread criticism, the United States may be paying less for hepatitis c virus drugs than other developed countries.
Curative hepatitis C virus antiviral drugs has been a topic of controversy for the last few years, largely due to the hefty price tag that comes with the drugs.
Solvaldi and Harvoni, 2 of the most well-known hepatitis C drugs, cost $84,000 and $94,500, respectively. Despite the high list prices, there has been little exploration of the negotiated net price.
A recent analysis from the IMS Institute of Healthcare Informatics studied the net prices, Medicare Part D and government-reimbursed prices various countries paid for Sovaldi and Harvoni. Investigators also looked at the prevalence of treatment in the United States and other countries. Net prices were gathered from public disclosures and media reports, and were discovered to be similar among different countries.
Investigators found that the European Union paid $45,056 per treatment course of Sovaldi, and the United States paid $44,520. Japan paid the lowest out of the countries studied, paying $43,000.
Harvoni cost approximately $52,279 in the European Union, and cost $55,517 in Japan. Interestingly, the drug only cost $50,400 in the United States.
The country with the second highest treatment rate was Japan, which treated 120,000 individuals with HCV. Other countries, such as the UK and France, only treated 7000 and 17,000 patients, respectively.
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Already, advocates are warning the White House that it needs to focus on small-scale interventions, like supporting needle exchange programs, making sure doctors can get reimbursed for so-called street medicine and investing in peer-navigators that help people get connected to care.
Collins said in an interview that the White House is learning from Louisiana, Washington, and other hepatitis C elimination efforts. He also shed light on further aspects of the program, like developing faster tests for the virus, that he says will help the federal government identify and treat hard-to-reach infections.
But he also emphasized the challenge of achieving the ultimate goal of eliminating hepatitis C.
This is going to be really hard. If it wasnt really hard, it probably would have just happened by now, Collins said. Were going to eliminate hepatitis C not because its easy, but because its hard.
When Washington and Louisiana set out on their effort to eliminate hepatitis C, a course of treatment could run as much as $94,500 even now, the medications retail for roughly $24,000 for a cure.
The deals, which provided drugs for Medicaid beneficiaries and people in the states prison systems, seemed like a genius way to get the miracle pills to the people who needed them the most.
Their ultimate goals were similar: Washington pledged to cure 80% of the people in the state by 2030. Louisiana gave itself until 2024.
Hepatitis C Treatment Estimates
Today, the Centers for Disease Control and Prevention released data on the first estimates of hepatitis C treatment, from 2014-2020, using data from a national prescription claims database, IMS Health & Quintilesexternal icon . The treatment estimates were presented at this years virtual American Association of the Study of Liver Disease meeting as a poster titled Hepatitis C treatment in the United States, 20142020 by Eyasu Teshale, MD, Division of Viral Hepatitis, CDC. The poster reported on the estimated number of people initiating hepatitis C treatment from 2014 to 2020 and summarized the characteristics of persons infected with hepatitis C who were treated in the United States with direct-acting antiviral agents during that same time period.
The study found that over the six years of the study, approximately 843,000 people with hepatitis C in the United States initiated treatment with DAAs, an average of 120,000 people treated each year. The number of people treated was highest in 2015 with 164,247 people treated, and then declined to its lowest level in 2020 with 83,740 people treated likely due to COVID-19-related disruptions to hepatitis C testing and treatment, and continued restrictions on coverage of HCV treatment by some insurers.
Additional select findings from the study include:
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But now, two years later, treatment rates are slowing and both states are drastically far from achieving their overarching goals.
As of September, Louisiana had treated less than 12,000 of the estimated 39,000 people with hepatitis C in its Medicaid program and prison system. The state would have to almost triple its recent treatment rates over the next 27 months if it wants to achieve its 2024 goal, but treatment rates in Louisiana instead appear to be dropping. The states Medicaid program treated just 3,111 of hepatitis C-positive people last year, down from 4,092 the year prior. And in the first three months of 2022, it started just 587 people on treatment across both Medicaid and its corrections population.
Washington, meanwhile, is now treating even fewer people than it was in the three years prior to signing its Netflix deal, when doctors wrote about 17,000 prescriptions for people on Medicaid. The states Medicaid program filled 6,649 hepatitis C prescriptions in 2017 alone. In 2021 that number dropped to just 2,409.
While some of the downturn in both states is likely due to the Covid-19 pandemic, treatment rates in Washington are dropping faster than the national average. Nationwide Medicaid prescriptions for hepatitis C medications dropped 15.6% from 2019 to 2020, while prescribing dropped 30.1% in Washington. Louisiana’s treatment rates between 2019 and 2020 actually increased by 18%, but then dropped by 22.8% from 2020 to 2021.
Why The High Costs
At this time, theres a short list of blockbuster HCV drugs. Because the FDA only recently approved these drugs, the companies that manufacture them have market exclusivity. That means only these companies can promote and sell the drugs. It also means there are no generic versions of these drugs yet. Generics are typically much cheaper than brand-name versions.
The FDA determines how long this period of exclusivity will last. During this time, the pharmaceutical companies have a lot of freedom in establishing prices. And those who developed the new HCV drugs have set the pricing bar high.
The table below highlights the average cost of treatment for the combination DAAs currently available. Most of these drugs take at least 12 weeks to cure HCV, while the most recently approved drug, Mavyret, can take only eight weeks.
These costs are averages derived from information provided by www.goodrx.com. They were current at the time this article was published.
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You May Not Need Treatment
Not everyone with hepatitis C will need to receive these expensive treatments. In up to of people with hepatitis C, the virus clears on its own within a few months without any need for medication. Your doctor will monitor you closely to see if your condition persists, and then decide if you need treatment.
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Hepatitis treatment pits patients against insurance companies and lawmakers against drugmakers. States, which cover a huge number of hepatitis sufferers like Tia, are stuck with some of the biggest bills.
There are probably a million people who have hepatitis C in the Medicaid world, said Matt Salo, director of the National Association of Medicaid Directors. When it costs $64,000 to cure hepatitis C, thats a great deal. Multiply that by a million people? Thats what made people freak out.
Tia, covered by Washington, D.C.s relatively generous Medicaid program, is in the middle of that big budget freak-out. Fighting for her cure has been a months-long battle.
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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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But Stern largely declined to criticize the Washington jail systems lack of progress, given the struggles with responding to the Covid-19 pandemic. If a year or two from now we are still in the same place that we are now, we would need to be more critical of ourselves, Stern added.
Louisiana has stood up more of the initiatives it promised than Washington, but it too has struggled with efforts to get hard-to-reach people, like those who inject drugs, into treatment.
Lauren Richey, the medical director of the Infectious Disease Center at the University Medical Center in New Orleans, said Louisiana’s efforts have made it infinitely easier for liver doctors like her to treat people with these medicines. But she acknowledged, too, that its still difficult to get hard-to-reach people to come through the clinic door.
We still have a lot of issues with young people, especially people actively using drugs. They still remain a challenging group to engage with, she said. In order for us to really get to the heart of this epidemic we have to invest in getting the people are the hardest to reach into care.
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What About Patients With Hepatitis C Who Also Have Hepatitis B
Hepatitis B virus can flare in patients who are co-infected with hepatitis B and hepatitis C and are taking medication for hepatitis C. This has been reported as a potential risk for patients who are taking hepatitis C treatment and have underlying hepatitis B as well. The flare usually occurs within a few weeks after the patient starts taking medication for hepatitis C. Therefore, patients who have both hepatitis B and hepatitis C should be seen by a hepatitis expertbeforestarting treatment of the hepatitis C they may need to start taking hepatitis B treatment to avoid a hepatitis B flare.
Risk Of Hcv Infection
Hepatitis is an inflammation of the liver that can lead to decreased liver function. Hepatitis can be caused by toxins, including alcohol and certain medications, or it can be caused by a virus. HCV is the virus that causes hepatitis C, or hep C. It is one of the most common hepatitis viruses.
HCV is transmitted through blood-to-blood contact. Before we had a screening test for hep C in 1992, most people got infected through blood transfusions. This explains why baby boomers, those born between 1945 and 1965, are five times more likely to have the virus.
Today, most people with the virus get infected by sharing needles or other equipment for injecting drugs. Recent research has shown that the growing opioid epidemic is driving up rates of hep C infection, especially among young people. In addition, the prison population is at high risk for infection because of the high number of injection drug users who enter correctional facilities who are already living with hep C. Inside prisons, hep C is transmitted through injection drug use and unsafe practices for tattoos and piercings. It is estimated that one in three people in U.S. jails and prisons have HCV.
Hep C can be transmitted through sexual activity however, this is rare and most likely to happen if a person is already living with HIV or another sexually transmitted infection. The Centers for Disease Control and Prevention estimates that 25% of people living with HIV also have HCV.
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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.