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Insurers Are Refusing to Pay for Life-Saving Hepatitis C Drugs

The new antiviral drugs for hepatitis C have revolutionized the treatment of this dreaded infection. But drug companies charge outrageous prices and insurance companies are refusing to pay.

One of the great pharmaceutical advances of the last decade has been the development of antiviral medications that are highly effective against hepatitis C (aka HEP C or HCV for hepatitis C virus). Keep in mind that 3.5 million Americans suffer from this potentially devastating condition. That’s the estimate from the CDC.

Many people don’t realize they are infected until they begin showing signs of liver damage. If not treated, some people can end up with liver failure or liver cancer. That’s why effective antiviral medications are so critical for people with this infection.

The Old Hepatitis C Treatments:

Before the new antiviral medications came along patients with hepatitis C were treated with weekly interferon injections. It could take six months to a year to complete the full course of treatment. This immune boosting approach was hard on the body. Patients often complained of fatigue, weakness, fever, chills, depression, anemia, hair loss, nausea, insomnia, muscle pain and diarrhea. Imagine having a terrible case of the flu week in and week out for up to a year.

The depression alone could be incapacitating. Some people developed autoimmune conditions that ranged from rheumatoid arthritis to psoriasis and lupus. It should come as no surprise to learn that many patients gave up on this challenging regimen.

The NEW Hepatitis C Drugs Are Amazing!

Oral antiviral medications for hepatitis C revolutionized treatment for this infection. Sofosbuvir (Solvadi) was the first medicine patients could take as a pill. Since then other antiviral drugs have been developed including the combination sofosbuvir and ledipasvir (Harvoni), telaprevir (Incivek), glecaprevir and pibrentasvir (Mavyret) and simeprevir (Olysio), to name just a few.

Such drugs are curative for the vast majority of patients (94% or better). The side effect profile has also become much more tolerable, with one exception. The cost of these medicines is astronomical. Some of the newest drugs can cost close to $100,000 for a course of treatment.

As a result of the prices, insurers are balking. A new study found that over half of people with private insurance were denied access to these drugs (Open Forum Infectious Diseases, June 7, 2018). The authors note:

“Despite the acknowledged benefits of HCV therapy, the high costs of DAAs [direct-acting antivirals] have led public and private insurers in the United States to restrict access to these medications.”

These investigators found:

“For DAA prescriptions submitted to a national specialty pharmacy between January 2016 and April 2017, 35.5% were absolutely denied by the insurance carrier. The incidence of absolute denial was higher among commercially insured (52.4%) and Medicaid (34.5%) beneficiaries compared with Medicare beneficiaries (14.7%).”

What Happens When Hepatitis C Treatment Is Denied?

The authors describe what happens when insurance companies reject modern HCV treatments:

“The high incidence of absolute denial of DAA therapy has important implications. From a clinical standpoint, patients denied access to HCV therapy remain at risk for the development of hepatic fibrosis, cirrhosis, liver decompensation, and hepatocellular carcinoma. Denial of DAA treatment can also lead to ongoing HCV-associated inflammation, which might increase the risk of extrahepatic complications. Further, failure to treat and cure chronic HCV maintains a reservoir of HCV transmission. From a public health standpoint, the high incidence of absolute denial of DAA treatment represents a major barrier to the goal of HCV elimination.”

In other words, if you do not cure HCV with one of the new highly effective HCV drugs, people will continue to get sick and die. People with the virus are likely to transmit the infection to others. This is a catastrophe.

Who’s to Blame?

There’s a lot of blame to go around. The price of the antiviral medications is outrageous. But insurance companies and state Medicaid programs should not be denying patients access to highly effective and safe treatments.

Insurance companies are increasingly denying patients access to procedures and treatments that are expensive. A physician may determine that a particular medicine is essential for someone’s health. But the insurance company can deny access on the grounds that the drug is not on its formulary (list of approved medications).

Why You Should Care!

Most Americans don’t think about hepatitis C. Since it doesn’t affect them, they figure it’s someone else’s problem. Out of sight, out of mind.

The German Lutheran minister, Martin Niemöller wrote about the passivity of German intellectuals in a famous poem. There are various translations. Here is one that we think serves as a warning for all Americans:

“First they came for the Socialists, and I did not speak out—

“Because I was not a Socialist.

“Then they came for the Trade Unionists, and I did not speak out—

“Because I was not a Trade Unionist.

“Then they came for the Jews, and I did not speak out—

“Because I was not a Jew.

“Then they came for me—and there was no one left to speak for me.”

What will we do if drug companies discover effective treatments for Alzheimer’s disease or other deadly neurological conditions like ALS or Parkinson’s disease? If insurance companies have to continue paying for increasingly unaffordable drugs for more and more patients, they will eventually go out of business.

We have already seen the cost of new cancer drugs reach the stratosphere. Immunotherapies can cost $100,000 to $150,000 for a course of treatment. Personalized treatment with something called CAR-T can run $400,000 or more. And the latest and greatest cancer treatment may reach as much as $1,000,000 (Wall Street Journal, April 26, 2018).

If drug companies can charge whatever they wish, the entire health care system will implode within a few years. Either that, or insurance companies, state Medicaid programs and even Medicare will deny coverage, just as they are doing with hepatitis C drugs. People will die as a result. Isn’t that rationing?

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.”.
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