Enroll In A Government Health Plan
If you cant get private health insurance, explore U.S. government health benefits. Besides looking into the Health Insurance Marketplace, if youre 65 or older or have a disability, you might qualify for Medicare, which is a federal health insurance program. Also, your income could qualify you for your states Medicaid program. Veterans can research VA health benefits, too.
‘we Are Going To Beat This’
In Tias case, Bordon ran the requested tests. He filed an appeal with the insurance company providing Tias Medicaid coverage.
This is crazy, Tia said as she waited to hear if she would be covered. I called back again and again. How can an insurance company say theyll only cover one treatment in a patients lifetime?
Because she had developed some cirrhosis, a board finally determined she was eligible to receive a second round of treatment. She was sick enough to qualify for Vosevi, a combination of three hepatitis C drugs thats approved for cases like hers.
She started taking it in April and is feeling optimistic. I am hoping my liver will regenerate, she said.
Bordon said indications are that Tias will, and the medication is knocking down the virus, he said. Shell be taking the pills for three months.
Two weeks in, Tia had good news. “The virus is almost undetectable,” she said.
I feel good, she added. I have a plan. We are going to beat this.
Update: As of July 20, after six weeks of treatment, a blood test could not detect any hepatitis virus in Tia’s blood.
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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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 youre pregnant, you must delay treatment until after your baby is born.
Speak to your doctor before starting hepatitis C treatment if youre planning to become pregnant in the near future.
Youll 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.
If you become pregnant during treatment, speak to your doctor as soon as possible to discuss your treatment options.
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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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.
When he visited nearby Johns Hopkins Hospital to get help, the medical team conducted a simple blood test to see if Pannell had hepatitis C.
Edema, a swelling of the feet, ankles, or legs due to a buildup in fluids, is a common symptom of cirrhosis.
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.
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.
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How Much Does Hepatitis C Treatment Cost
The cost of hep C treatment varies depending on the type of drug. However, an 8- to 12-week course can range from $54,000 to $95,000 .
For example, the price of a 12-week course of Zepatier can be as much as $54,600, and a 12-week course of Harvoni can cost as much as $94,500.
Without insurance, youre responsible for the full amount out-of-pocket. And even with insurance, the cost can range into the thousands, after adding in drug copays and coinsurance.
If you qualify for patient assistant programs, you might receive your medication for as little as $5 out-of-pocket.
How Much Is Hepatitis C Drugs Pricing Disclosure Outside Insurance
2. Hepatitis C medications are expensive Antiviral medications for hepatitis C are highly effective, but come at a high price. Just one Sovaldi medication costs $1,000. A 12-week treatment session with this medication costs $84,000. Other hepatitis C medicines are likewise expensive: A 12-week therapy with Harvoni costs $94,500.12-week therapy with Mavyret costs $39,600.
Zepatier therapy costs $54,600 for 12 weeks Treatment with Technivie costs $76,653 for 12 weeks. Drugs for hepatitis C are expensive due to their great demand and the high price of bringing them to market. Developing a new treatment, testing it in clinical trials, and selling it can cost almost $900 million for pharmaceutical corporations.
The absence of a national health care system to negotiate prescription rates on behalf of customers also contributes to the high cost. Also, there is limited rivalry from other pharmaceutical businesses. Consequently, hepatitis C medicine producers may charge practically whatever they want.
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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.
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.
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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.
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Is Treatment For Hepatitis C Covered By Insurance
Due to the high cost of certain drugs, coverage is contingent on your meeting a number of restrictions. For instance, many individuals have a little window to obtain coverage for Sovaldi. If your liver condition has progressed too far, your insurance company may refuse your coverage request.
- If you have serious kidney impairment, you are no longer regarded an appropriate candidate for this drug.
- Depending on your insurance plan, the degree of coverage you may receive for the cost of these prescriptions can vary.
- Numerous individuals have managed care plans.
- The foundation of managed care programs is contracts with healthcare providers and medical institutions.
These programs can provide members care at discounted prices. There are three fundamental categories of managed care plans: Management of health care preferred provider point of service Most health insurance policies stipulate that HCV treatment must be medically required.
- Whether or not a treatment is considered medically essential depends on the coverage policy of each plan.
- Prior to receiving a recommendation for antiviral medication, BlueCross BlueShield of Mississippi, for instance, demands a six-month review period.
- With rare exceptions, not all health insurance policies cover all prescription drugs for HCV therapy.
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Stat+: Exclusive Analysis Of Biopharma Health Policy And The Life Sciences
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.
Differences In Hepatitis B And C Treatments
Guidelines for the medical treatment of a co-infection with hepatitis B and C have not been clearly set, according to Ibrahim Hanouneh, MD, a hepatologist at the Cleveland Clinic. There are scant data and no standard-of-care recommendations, he says. But limited research suggests treatment for hepatitis C is still effective even in the presence of the hepatitis B virus, he adds.
Medications for hepatitis C have improved dramatically in recent years. Not only are newer hepatitis C drugs easier for people to take, with fewer and less severe side effects, but theyre also effective, Alqahtani says, and cure rates are excellent.
For chronic hepatitis B infection, however, theres currently no cure. Treatment involves slowing the progression of the virus and monitoring people for signs of liver damage, according to the CDC.
For this reason, Alqahtani says, doctors try to determine which virus is dominant in people with co-infection. We check the liver to see which virus is more active, he says. If its hepatitis C, we treat that virus first. Once its cured, he says, the focus of treatment shifts to controlling hepatitis B.
Treatment for co-infection comes with specific concerns that should be monitored by your healthcare team, including:
- Liver transplant may be an option: People who develop severe cases of co-infection that result in liver failure may be candidates for liver transplant, Alqahtani says.
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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
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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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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