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The new-gen treatments for Hep C can make the illness go away, but their extreme price tags make insurance co-pays unaffordable, and many patients just stay sick.
Bill RemakPatients living with the Hepatitis C virus (HCV) have been a vital force in providing education about the disease, encouraging testing, easing the associated stigma, and advocating for research and development of newer, less invasive therapies. As we observe Hepatitis Awareness Month throughout May, advances in HCV treatment offer new hope for a cure to more than five million hepatitis C patients in the United States and nearly 175 million others throughout the world.
Hepatitis C is a blood-borne infectious disease most commonly spread through blood-to-blood contact. If undiagnosed, the disease can lead to cirrhosis, liver transplants, and liver cancer. HCV is now responsible for more annual deaths in the United States than the total of HIV/AIDS deaths. And about one-third of HIV/AIDS deaths are attributed to complications of Hepatitis C as a co-morbid condition.
Effective new cures for the hepatitis C virus now bring real hope to U.S. patients. Older HCV treatments carried significant risk; greater likelihood of complications, often-debilitating side effects, or harmful adverse reactions; and low cure rates. The treatment regimens led to a success rate of less than 50% for patients who completed the course of treatment, while up to 80% of patients discontinued treatment altogether, usually on the advice of their physicians.
A recent study comparing older and newer treatments concluded that newer medications provide much higher cure rates, exceeding 95% with a single 12-week therapy.
While these new treatments are available, in the private health insurance marketplace some patients will not be able to afford them and will continue to suffer needlessly as their disease worsens.
Health insurers use “specialty-tier” pricing structures that place vital medications beyond the reach of many patients. These practices jeopardize patient health and discriminate against patients living with a range of chronic and life-threatening conditions, including viral hepatitis.
In California, patient groups such as the California Chronic Care Coalition have urged health officials to take action to end discriminatory specialty-tier insurance practices and ensure patient access to affordable specialty medications.
Stakeholder groups nationwide have joined the conversation around access to innovative therapies. As a result, the California Chronic Care Coalition (www.chroniccareca.org) has launched the National Stakeholders Medication Collaborative, which will serve as an advocacy hub for groups looking for solutions to specialty tier pricing and rising out-of-pocket costs.
For patients with chronic conditions who need to take multiple medications, costs can range from hundreds to thousands of dollars. Many patients who cannot cover their out-of-pocket costs intentionally discontinue their medication use in order to pay for rent and food. This often leads to health complications, emergency hospital visits, and lost work and productivity.
When these situations occur, pharmacists are uniquely placed to provide guidance to patients about the complications that may arise if medication adherence is abandoned.
Recent studies suggest that, compared to patients without the virus, HCV patients average more than five times the hospitalizations and more than three times the number of emergency visits. The average annual healthcare cost for a Hepatitis C-infected individual is $23,484 - five times higher than that of patients without the virus.
Across the country, annual nonadherence results in more than $100 million in annual direct costs to the healthcare system and $2 billion in annual lost patient earnings and productivity.
As patients’ out-of-pocket costs continue to climb, partnerships between patients and healthcare providers will be critical to achieving better outcomes for vulnerable patient populations.
Pharmacists are trusted health partners to patients. In a world that combines a coordinated care team model with the new health paradigm based on cures that prevent and treat chronic diseases such as hepatitis, cancer and others, pharmacists will be the game changer.
While this shift occurs, it is essential that any economic disparities that cause barriers to medication access be resolved.
Bill Remak is founder and CEO of the California Hepatitis C Task Force and founding board member of the California Chronic Care Coalition. He is an associate member of the Marin County Pharmacists Association. Contact him at firstname.lastname@example.org.