By Marcus Hopkins, Blogger
One of our primary concerns, here at the HEAL Blog, is the affordability of treatment for those mono- or co-infected with Hepatitis C. Arguably the most highly discussed treatment option for HCV is Sovaldi, one of the newer therapies offered by Gilead Sciences, largely because of the high price tag associated with the drug. Coming in at an estimated $85k for a twelve-week treatment regimen, the controversy over pharmaceutical pricing has been reignited in a way not seen in over a decade.
But, when considering the affordability of treatment, more factors must be taken into account than simply the price of the pill, itself; beyond the initial sticker shock, one must also consider factors such as base income levels and, in a more recent twist in the equation, the impact that expanded marriage rights for same-sex couples may have on the ability to afford insurance coverage, as well as for meeting income requirements for coverage assistance.
This new dynamic may change the way people think about paying for medications. There is overwhelming demographic evidence that those infected with HIV and/or HCV tend to fall in lower income brackets. This creates an interesting conundrum on the payer side of the equation, as treatment options for HIV and HCV are some of the most expensive in the industry; as such, reliance on payment assistance is greater in these communities than virtually any other.
Roughly 54% of those currently seeking treatment HIV currently receive some form of payment assistance, be that Ryan White or other Patient Assistance Programs (PAPs). The numbers for HCV patients requiring assistance are not yet so easily nailed down, as the most expensive options (that may require assistance to afford) have been on the market for less than a year; given that HCV infection numbers can, and often do, outstrip HIV infections, it stands to reason that the percentage of people who need payment assistance will likely be higher, especially considering the considerably higher cost of treatment.
In most cases, patients whose income falls below 138% of the Federal Poverty Level (FPL) will qualify for coverage by Medicaid (in states whose legislatures have chosen to accept the Federal Medicaid Expansion established by the Affordable Care Act).
Those patients whose incomes require them to purchase individual coverage under the Individual Mandate portion of the ACA often face relatively astronomical co-pays for HIV/HCV medications, as most (if not all) private insurers have placed these drugs into higher pricing tiers.
In these circumstances, consumers who believed that purchasing insurance via an ACA-approved exchange program would serve as a boon still find themselves in the position they were in prior to having insurance – unable to afford the treatments they need in order to address their health issues.
This is where Patient Assistance Programs exist to fill the gap. PAPs can help to provide patients with linkage to care that many have previously considered out of the question. Many drug manufacturers, as well as non-profit entities, provide these programs to help make treatment an affordable option for those choose to seek out assistance.
Gilead Sciences has fantastic PAPs for both their HIV and HCV medications that help to address issues of affordability for patients whose income levels serve as a barrier to treatment, as do most pharmaceutical companies in all fairness. In order for patients to qualify for these programs, they must meet certain income requirements, the thresholds for which are generous, to say the very least (and, sadly, more generous than those requirements set for Federally funded programs, such as Medicaid, Medicare, and the Ryan White program, all of which vary from state to state).
For Sovaldi, Gilead offers two separate PAPs: Co-Pay Assistance and Support Path, the latter of which may provide full coverage of the cost of medication. Both programs have specific income requirements – an income of up to $100k for families of up to three and up to 500% of the FPL for families of four or more.
These qualifications represent an opportunity for patients needing access to treatment, especially when compared to the requirements for the Federally funded programs. They can provide a vital linkage to care that people may not otherwise have. And it’s not just Gilead that provides these programs – several drug manufacturers provide similar programs, such as Johnson & Johnson/Janssen, Merck, and Vertex Pharmaceuticals, just to name a few.
At a time when the affordability of healthcare is in such sharp focus, the existence of these programs is a welcome addition to the healthcare community. The HEAL Blog will continue to wave the cautionary red flag over drug pricing, when appropriate, but it is also incumbent upon us to raise awareness about PAPs and other patient assistance programs.
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. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.