Cost Burden Of Hepatitis C Virus Treatment In Commercially Insured Patients
Anita Wagner, PharmDThe American Journal of Managed Care
Rates of hepatitis C virus treatment in a commercially insured population doubled after availability of new direct-acting antivirals. Member out-of-pocket spending was kept low while the health plan bore 99% of spending on HCV medications.
Objectives: New direct-acting antivirals , introduced in late 2013, are effective for treating chronic hepatitis C virus infection but may pose substantial financial burden on patients and health insurers. We examined HCV medication use and costs in a commercially insured population.
Study Design: Retrospective cohort study.
Methods: We used claims data for 3091 individuals with HCV infection . Outcomes included HCV medication use, inflation-adjusted out-of-pocket and health plan spending, and predictors of receiving new DAAs.
Results: Cumulatively, 9% of members with a diagnosis of HCV were treated with HCV medications in 2012 and this increased to 32% in 2015. Of 3091, 589 received new DAAs and 80% completed a 12-week treatment regimen. After new DAAs became available, average annual health plan spending on HCV medications increased from $2869 to $16,504 per HCV-diagnosed member , and OOP spending increased from $41 to $94 . Age and having liver cirrhosis were positively associated with receiving new DAAs, and a diagnosis of alcohol abuse was negatively associated with receiving new DAAs.
Am J Manag Care. 2019 25:e379-e387Takeaway Points
Setting and Data Source
Hcv Symptoms And Screening
Acute infection often has no symptoms or has symptoms that are mild and/or mistaken for other common illnesses. And chronic infection occurs over the course of years or even decades, again with symptoms — such as fatigue and depression — that are often attributed to a different cause. In fact, it is estimated that 50% of the 3.9 million adults who are living with HCV in the U.S. do not know it.
The CDC recommends that all adults born between 1945 and 1965, anyone who got clotting factor before 1987, and anyone who received a blood transfusion or organ transplant before 1992 be screened at least once. The agency also recommends screening for long-term hemodialysis patients, as well as anyone who has ever shared needles for drug use , gotten an unregulated tattoo, or has HIV. In addition, the U.S. Preventive Services Task Force recommends that everyone in the prison population be tested for HCV.
Unfortunately, we do not have a robust screening and surveillance system in place to track hepatitis C infections the way we do for HIV. In 2017, only 14 states received money from the CDC for HCV surveillance . And only 22 states require HCV testing for those coming into prison. Moreover, a recent survey of health care providers found that fewer than 30% are following the CDC’s screening recommendations.
Explore Patient Assistance Programs
If youre uninsured or underinsured, you may be eligible to receive financial help from one of the companies that manufactures hepatitis C medication. Each of these companies offers some sort of financial assistance program for people without insurance. Meanwhile, various non-profit organizations may be able to help you afford expensive co-pays, and pharmaceutical companies may also offer their own co-pay assistance programs. A comprehensive list of available patient assistance programs can be found on the NVHR website.
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How Much Hepatitis C Medications Actually Cost
Unfortunately, even qualifying for the treatment doesnt mean getting it. With many health insurance plans the deductibles remain ridiculously high.
For example, those who benefit from Medicare health plans have a 50-50 chance of getting their treatment with Viekira Pak® covered. According to GoodRx, the deductible varies anywhere from $7,900 to $32,000, per month.
Technically, almost any Medicare plan will cover hep C treatment with Harvoni®, but the extent of the coverage is undependable. The majority of the plans only cover the treatment for the first 30 days.
In reality it means that your deductible for the first month can be in the $9,000 range, but the treatment for each subsequent month will come with $32,000 bill.
For the reference, recommended treatment duration is either three or six months, depending on previous treatment history with interferon and the exact stage of liver disease. Only in some rare cases the treatment duration can be reduced to two months, but never to one.
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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How Effective Is Treatment
Direct acting antivirals cure 9 out of 10 patients with hepatitis C.
Successful treatment does not give you any protection against another hepatitis C infection. You can still catch it again.
There’s no vaccine for hepatitis C.
If treatment does not work, it may be repeated, extended, or a different combination of medicines may be tried.
Your doctor or nurse will be able to advise you.
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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Healthnew Group Takes On Drug Prices And Big Pharma
The prices of the hepatitis C drugs are coming down as more companies develop their own versions and competition kicks in. AbbVies Mavyret is priced at $26,400 for a treatment round, a price that has pressured other companies to lower their prices.
Now that there are multiple drugs on the market, prices have obviously been driven down, Dieterich said. The insurance companies have contracted with pharma and they have their preferred products, he added.
But still, he said, insurance companies and state Medicaid programs often put up barriers if they can.
There are always plans that are trying to get out of itby having alcohol tests or marijuana tests. Even if you are smoking marijuana, theyll exclude them, Dieterich said.
Last October, the AIDS Institute, which also represents patients with hepatitis, said 31 states and Washington, D.C. decline to treat patients until they have moderate or worse liver damage.
Or they balk at treating patients, like Tia, whose first course of treatment fails.
Freeing Yourself From Hcv For Good
With a cure in hand, worldwide elimination of HCV is possible. But according to the most recent data, only 12 countries in the world were on track to eliminate HCV, according to the World Health Organization. With sporadic testing and low treatment, the United States is not among them. Instead, ongoing battles over insurance coverage and drug cost mean only about one in five people living with HCV in the U.S. has been treated. If you are living with HCV, find a doctor who will fight for your health, and dont give up. A cure is out there.
Hep C Treatment Approved: Centers for Disease Control and Prevention. . Hepatitis C: Questions and Answers for Health Professionals. cdc.gov/hepatitis/hcv/hcvfaq.htm#a3
HCV and One in 7 Cured:Journal of General Internal Medicine. . The HCV Treatment Cascade: Race Is a Factor to Consider.
HCV Elimination and Only 12 Countries:World Journal of Gastroenterology. . Hepatitis elimination by 2030. Progress and challenges. ncbi.nlm.nih.gov/pmc/articles/PMC6262254/
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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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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.
The Best Treatment For Hep C: Daas
Since their FDA approval in 2014, direct-acting antivirals have been regarded as the most effective treatment option for hepatitis C patients with impressive cure rates, and 2020 is looking like no exception .
Currently, the most recently approved DAAs are Mavyret and Vosevi, both of which came to market in 2017 . Wholesale Mavyret will run you roughly $24,000 while Vosevi can be up to $74,000 for a 12-week treatment period. And, in those numbers, the issues of cost and access begin to reveal themselves.
As DAAs continue to evolve, theyre being designed to have fewer side effects and quicker treatment durations. One such phase 2 clinical trial with published findings in Hepatology, found 6-8 week reduced treatment periods to be highly effective for several FDA approved DAAs including odalasvir and simeprevir .
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Apply For Patient Assistance Programs
Another option is patient assistance programs.These are sponsored by pharmaceutical companies and give those in low-income households access to medications.
Keep in mind that youre only eligible for patient assistance programs if you arenot enrolled in Medicare, Medicaid, or another government prescription plan. These programs provide financial assistance, reducing your copays and coinsurance for medication.
Assistance varies, so youll need to contact drug companies directly to learn about their specific programs. Some examples include:
The National Viral Hepatitis Roundtable also provides information on getting financial assistance or copay relief.
Will Insurance Cover Treatments
Patient assistance programmes can help reduce the cost of treatments if an insurance plan does not provide cover.
The level of insurance cover for hepatitis C treatments can vary, depending on a persons insurance policy and overall health.
Some insurance companies will pay for people whose hepatitis C has not responded to less-expensive treatments or for those who are already showing signs of liver damage.
Some insurance companies may require a person to prove they have been drug- and alcohol-free before authorizing treatment.
Insurance companies may believe people who fall into these categories will cost them less money.
If a person has a hepatitis C diagnosis, they may first ask what treatments their doctor recommends. Then, they should contact their insurance company to find out what medications their insurance plan may cover.
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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.
How Much Does Epclusa Cost
Epclusa comprises Velpatasvir and Sofosbuvir which are antiviral medicines. Sofosbuvir and Velpatasvir can thus prevent HCV from spreading in your body. You can use Epclusa to treat hepatitis C if it is chronical in natural and especially. In special cases where an adult is suffering from advanced cirrhosis. The Epclusa is combined with ribavirin, another antiviral medicine to treat the disease. Epclusa has the ability to treat only certain genotypes of hepatitis C, to present in a specific individual only. Although Epclusa Cost is very high in the USA, Russia, Mexico, UK, Austalia, Europe, Germany, Canada in other countries due to low-income people prefer to buy generic Epclusa. It is strictly recommended to follow the medications. That is prescribed particularly to you and never share medicines with another individual under any circumstances.
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Q: What’s The Future Likely To Hold And Will Prices Decline
Several other hepatitis C drugs are under study, and competition may solve the cost problem, or least improve it. ”To some extent this is probably going to be a self-correcting problem,” Carey says. ”Although Gilead and Johnson & Johnson have the corner on the market now, there are plenty of other drugs in development.” As those drugs become approved, supply and demand will drive down the costs of the two current drugs.
One oral drug under development, known as ABT-450, cured more than 95% of patients, even in some who weren’t helped by other treatments. The study results were presented at the annual meeting of the European Association for the Study of the Liver in London Thursday and published in the New England Journal of Medicine online. The study was funded by AbbVie, the maker of the new drug.
Also this weekend, scientists reported positive results using Sovaldi in combination with another Gilead drug, ledipasvir. Those results were published in the April 12 issue of the New England Journal of Medicine.
An editorial in the same issue of the journal describes the results as âexcitingâ but says, “The major limitation remaining will be economic.” Using current cost estimates, the experts say, treating even half of the infected people in the U.S. ”would add billions of dollars to an already overburdened medical care system.”
But pressure to lower those costs is increasing.
Pregnancy And Hepatitis C
The new hepatitis C medicines have not been tested in pregnancy.
You should not become pregnant while taking treatment as it could be harmful to unborn babies.
If you’re pregnant, you must delay treatment until after your baby is born.
Speak to your doctor before starting hepatitis C treatment if you’re planning to become pregnant in the near future.
You’ll need to wait several weeks after treatment has ended before trying to get pregnant.
Women taking ribavirin should use contraception during treatment and for another 4 months after the end of treatment.
Men taking ribavirin should use a condom during treatment and for another 7 months after the end of treatment. This is because semen can contain ribavirin.
If you become pregnant during treatment, speak to your doctor as soon as possible to discuss your treatment options.
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