Monthly Archives: November 2013

The HCV Treatment Horizon

By: Marcus Hopkins, HEAL blogger

HIV/HCV co-infection has been a growing problem over the past decade, and only now are there effective, cost-friendly treatments available to healthcare consumers. Until recently, significant issues existed with interactions between treatment for HCV and drug therapies for HIV.

In the near future, very effective options for treatment for HIV/HCV co-infection will be on the market, and with that in mind, healthcare providers and educators need to be prepared to disseminate this information to patients and consumers. Additionally, we need to ensure that the relevant insurance covers these drugs in order to provide patients with the best possible care.

The current treatment regimens (Pegasys and PegIntron) last for up to a year and carry with them myriad notorious side effects, while offering only modest cure rate, especially for patients with unfavorable factors such as advanced liver fibrosis (L. Highleyman, Oct. 2013). Some of the recent developments in direct-acting antivirals are somewhat revolutionary in the treatment of HCV, particularly in those also infected with HIV.

An interferon-free regimen of Sofosbuvirs combined with Ribavirin taken for 24 weeks cured ¾ of previously untreated HIV+ people co-infected with HCV genotype 1, while twelve weeks cures 88% and 67% of those with genotypes 2 and 3 (respectively). This bodes very well for treatment regimens in the coming years.

This is but a single drug coming down the pipe – several other drugs from various companies show promising results, as well. Regardless of the promise shown by these drugs, a more pressing concern is whether or not healthcare providers, educators, and patients will be aware of them.

It behooves us to be aware of whether or not insurance companies will be covering HCV treatment in addition to the HIV treatments currently covered; if they are not going to be covered, what programs are available for those in need to cover the cost of treatment?

One of the primary barriers to care is the belief that treatment is expensive – those fears are not wrong. While expensive, there are several programs that cover either a portion or the entire cost of medications for those with lower incomes. These programs generally cover treatment for other STDs/STIs, but a legitimate concern arises every time new treatments are released into the formulary – will Medicaid and other programs be expanded to include these drugs?

The general answer is, “Yes.”

The new all-oral HCV treatment options will have incredibly expensive WACs (Wholesale Acquisition Costs), meaning high “list” and “public” pricing models. The currently FDA approved treatments from Merck and Vertex cost between $60,000 – $80,000, depending on the length of treatment.

This leaves us with two questions:

1.) What co-pay assistance will be offered by the drug companies?

2.) What Patient Assistance Programs (PAP) will be offered, and with what eligibility levels?

In answer to the first question, the current trend shows that both Merck and Vertex are willing to work with low-income patients. For patients taking the Merck treatment, a card can be printed out from http://www.pegintron.com or http://www.merck-cares.com which offers eligible patients up to $200 savings on their copayment for each PegIntron prescription, on up to 12 prescriptions. The savings are similar for those taking Victrelis.

These savings, however, apply only to those already covered by private insurance, which leads us to our second question.

Unfortunately, this question is not so easy to answer. To say that the income restrictions for coverage will be severely steep would be putting it very lightly, at best. The current income caps are so low as to be prohibitive. Regardless of the work that advocates have been doing with pharmaceutical companies (even if no pricing structure can be discussed prior to industry drug approval), it is very likely that those least likely to be able to afford will continue to face seemingly insurmountable barriers to treatment.

To be honest, it’s difficult for me to discuss pharmaceutical pricing without losing objectivity. As someone who has been and still is a recipient of the AIDS Drug Assistance Program (ADAP), and soon to be Medicaid in the state of WV, I have trouble remaining both calm and rational – the prohibitive pricing structure of treatment for the deadliest of diseases and illnesses infuriates me to the point of violence. Pricing was part of why my mother and I joined Act Up in the 1980s in New York, and though prices have dropped substantially for the quality and results achieved, they still remain problematic.

That in mind, I have to say that I am not optimistic that the WAC will be consumer-friendly, and from a profit-driven Capitalist perspective, why should they be? When your potential global market is in the hundreds of millions, what incentive is there to introduce revolutionary treatments at an affordable price?

But this, unfortunately, is the problem with a for-profit healthcare model – regardless of how low the cost to consumers, the bottom line of the pharmaceutical/insurance companies always comes first.

When consumers hear of a “price war” between private insurers and “Big Pharma,” the understanding is that it’s to see who can negotiate a lower price. Were healthcare a traditional industry, this might be the case; the reality, however, is quite the opposite.

Insurance companies frequently go out of their way to set the cost of co-pays and deductible as high as feasibly possible without scaring away consumers; Big Pharma, in turn, counters by offering co-pay assistance programs that cover part or all of the out-of-pocket costs for consumers, all of which create an extra unnecessary barrier to treatment. To boil it down, the rich get richer, some sick get better, but most are simply priced out of the market so frequently that they don’t even bother trying.

Regardless of how hopeless the outlook or how prohibitive the barriers, for now we must be diligent in ensuring that all healthcare providers are well-informed when it comes to treating co-infected HIV/HCV patients, and that they have adequate information to provide their patients the best service possible.

Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates.

Leave a comment

Filed under Uncategorized

HIV-positive patients and Hepatitis screening

By: Marcus Hopkins, HEAL blogger

HIV / HCV Co-Infection

HIV/HCV Co-Infection

One of the worst diagnoses a person can receive is that they have tested positive for HIV. Once you’ve received that information, it is all but guaranteed that your life will change. When I tested Positive, my first concern wasn’t that I was going to die – it was making sure that I didn’t contract anything else. The sad reality, however, is that a good rule of thumb for healthcare professionals is, “If they’ve been exposed to one [STD/STI], they’ve very likely been exposed to another.”

HIV and Hepatitis C coinfection is a growing problem, not only in the United States, but across the globe. The CDC estimates that roughly 1/3 of people living with HIV are currently coinfected with either Hepatitis B or Hepatitis C, with more people infected with HCV than HBV. More shockingly to me, however, was the fact that liver disease – much of which is related to HCV and HBV – has become the leading cause of non-AIDS-related deaths in people living with HIV.

But, is enough attention being paid to the risk of coinfection in our community? Demonstrably, no. So the question then becomes, “How do we raise awareness within the health provider and educator communities to communicate this information to their patients and class member?”

Once again, there are no easy answers; and, as with trying to get patients to comply with their treatment regimens, the biggest challenge is compliance. When treating patients, you’re already in an emotionally sensitive and time-sensitive situation – asking a doctor or nurse to provide additional information takes time away seeing other patients, but it is vital that this information be communicated.

More important is the need for testing. HIV+ patients are current not routinely screened for HCV, even though we now have rapid testing available. That, in my opinion, is unconscionable. In my own experience, I have been screened for it several times, in numerous states (FL, TN, CA, and WV) over the past seven years, and have thankfully come up negative with each test, but that does not mean that I should not remain vigilant. It does, however, mean that my healthcare providers were consistently providing adequate care and doing their due diligence to ensure that I was properly equipped with the tools I needed to adequately manage my own condition.

Further to that point, we, as educators, are not doing our own due diligence to make sure that information about HCV is reaching at-risk populations. As I mentioned before, HBV and HCV ostensibly account for many of the non-AIDS-related deaths in the HIV community; despite this information, the importance of regular Hepatitis screening and the possible need for fast and immediate treatment are not part of the daily conversation in the HIV+ community. How can we possibly express the severity of the issue if we, ourselves, are not actively participating in the process?

Going forward, we need to ensure that healthcare providers are pushing testing for HBV and HCV, if only because it provides them with more information that can guide how providers approach treatment. Knowing which medications to prescribe in order to accommodate the additional strain put on the liver is paramount in ensuring that the Hepatitis virus is controlled in addition to treating HIV.

So, how do we do this? That’s where the easy solutions end. Getting healthcare providers and educators to disseminate this information is a process, and one that takes time to put into place; ensuring that they comply with that process is just another step that requires diligence and consistency, and at current staffing levels, it’s not quite clear whether or not we can live up to any new standards.

As far as an information campaign is concerned, we need to insure that whatever information is available is compiled in a way that is easy both to find and to understand if we’re ever to overcome the education barriers that stand between HIV patients and understanding the risk of coinfection. As an educator, even I have trouble finding credible information from reliable sources, which points to a lack of cooperation between organizations that needs to be addressed in the near future. We need to pool our resources, rather than allowing each organization to do its own thing. While some may argue that centralizing the education effort reduces the number of options healthcare consumers have when deciding upon treatment methods, the crisis we face requires that we bite the figurative bullet and get it together in order to better serve a population desperately in need of outreach.

Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates.

Leave a comment

Filed under Uncategorized