Hepatitis C treatment underused because of high cost and insurance restrictions : Shots

Hepatitis C can cause severe liver damage and leads to about 15,000 deaths in the U.S. each year.

James Cavallini /BSIP/Universal Images

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James Cavallini /BSIP/Universal Images

Hepatitis C can cause severe liver damage and leads to about 15,000 deaths in the U.S. each year.

James Cavallini /BSIP/Universal Images

Ten years ago, safe and effective treatments for hepatitis C became available.

These pills are easy-to-take oral antivirals with few side effects. They cure 95% of patients who take them. The treatments are also expensive, coming in at $20 to 25,000 dollars a course.

A new report from the Centers for Disease Control and Prevention finds that the high cost of the drugs, along with coverage restrictions imposed by insurers, have kept many people diagnosed with hepatitis C from accessing curative treatments in the past decade.

The CDC estimates that 2.4 million people in the U.S. are living with hepatitis C, a liver disease caused by a virus that spreads through contact with the blood of an infected person. Currently, the most common route of infection in the U.S. is through sharing needles and syringes used for injecting drugs. It can also be transmitted through sex, and via childbirth. Untreated, it can cause severe liver damage and liver cancer, and it leads to some 15,000 deaths in the U.S. each year.

“We have the tools…to eliminate hep C in our country,” says Dr. Carolyn Wester, director of the CDC’s Division of Viral Hepatitis, “It’s a matter of having the will as a society to make sure these resources are available to all populations with hep C.”

High cost and insurance restrictions limit access

According to CDC’s analysis, just 34% of people known to have hep C in the past decade have been cured or cleared of the virus. Nearly a million people in the U.S. are living with undiagnosed hep C. Among those who have received hep C diagnoses over the past decade, more than half a million have not accessed treatments.

The medication’s high cost has led insurers to place “obstacles in the way of people and their doctors,” Wester says. Some commercial insurance providers and state Medicaid programs won’t allow patients to get the medication until they see a specialist, abstain from drug use, or reach advanced stage liver disease.

“These restrictions are not in line with medical guidance,” says Wester, “The national recommendation for hepatitis C treatment is that everybody who has hepatitis C should be cured.”

To tackle the problem of languishing hep C treatment uptake, the Biden Administration has proposed a National Hepatitis C Elimination Program, led by Dr. Francis Collins, former director of the National Institutes of Health.

“The program will prevent cases of liver cancer and liver failure. It will save thousands of lives. And it will be more than paid for by future reductions in health care costs,” Collins said, in a CDC teleconference with reporters on Thursday.

The plan proposes a subscription model to increase access to hep C drugs, in which the government would negotiate with drugmakers to agree on a lump sum payment, “and then they would make the drugs available for free to anybody on Medicaid, who’s uninsured, who’s in the prison system, or is on a Native American reservation,” Collins says, adding that this model for hep C drugs has been successfully piloted in Louisiana.

The five-year, $11.3 billion program is currently under consideration in Congress.