More Sad News on the Home Front

By: Marcus J. Hopkins, Blogger

LOGO: Center for Improving Value in Health Care (CIVHC)

Photo Source: CIVHC

A May 19th report from Colorado Public Radio cited a study from the non-profit Center for Improving Value in Health Care (CIVHC) that found that, “…in spite of the availability of new revolutionary drugs, 89 percent of Coloradans [in] (sic) with Hepatitis C did not receive any treatment for their condition.” This number was reached by analyzing claims data from the Colorado All Payer Claims Database (CO APCD) for the commercial insured (excluding those on self-insured plans), Medicaid, and Medicare Advantage members in 2013 and 2014.

What makes this study so frustrating, for me, is that I’ve been following the progress of Colorado’s healthcare system as it relates to HCV and HIV since the beginning of 2015, and have to say that, while there will always be some people who are denied coverage, Colorado’s healthcare provisions are some of the best in the nation, particularly for co-infected patients living in the state. In comparison to several other states, Colorado’s Medicaid coverage for HCV Direct Acting Agents (DAAs) is one of the most comprehensive coverage models in the nation, and the amazing work being done by the state’s AIDS Drug Assistance Program (ADAP) is beyond reproach.

On the ADAP side of the equation, the program was one of the first in the nation to offer coverage for their co-infected patients through one of their five payer formularies – Standard ADAP Formulary (for the uninsured), HIV Medication Assistance Program (HMAP), Bridging the Gap Colorado (BTGC), HIV Insurance Assistance Program (HIAP), and Supplemental Wrap-Around Program (SWAP). For their uninsured clients, they consistently offer coverage up to the point where funds are no longer available for treatment, and have made significant strides toward including additional funds in their annual budget for treatment of HCV.

So, when I read that 90% of Coloradans diagnosed with HCV are not receiving treatment, I had to look a little bit further into the study. What troubles me is that the data is representative of the years 2013 and 2014, two of the most, if not the most we’re likely to see, volatile years for the HCV treatment landscape. Gilead Sciences and Janssen Pharmaceutical released Sovaldi and Olysio, two drugs that were meant to serve as companions in a new twelve-week regimen to treat HCV. Gilead’s product, alone, came out with an introductory Wholesale Acquisition Cost (WAC) of $87,000 for twelve weeks of treatment; when Olysio was factored in at around $45,000, treatment ostensibly could cost roughly $130,000 for just twelve weeks.

The sticker shock of Sovaldi, and later Harvoni (Gilead), was so great that there were Congressional hearing on the matter, wherein Medicaid, Medicare, Veterans Administration, and private insurers all balked at the high costs associated with these drugs and sounded the klaxon that paying for these drugs to treat all their clients infected with HCV would bankrupt them all. And, honestly, they weren’t wrong. A lot of time and energy went into fighting against these high prices, finding ways to pay for treatment, and pushing for greater oversight and funding for the problem.

In just two years’ time, the standard of care for HCV was essentially rewritten to the point where the old treatments were essentially dismissed by the medical community for being too difficult to tolerate and too costly to keep repeating literally ad nauseam. Then, in 2015, the treatment landscape started to turn around, with more private insurers and public payers’ coverage practices coming under scrutiny. At the end of 2015, the Centers for Medicare and Medicaid Services (CMS) released very specific guidance instructing state Medicaid agencies to stop rationing care, as the were in violation of very clearly stated statutes that required them to cover the drugs for patients. Some states – Arizona for example – specifically stated that they would not be in compliance.

But, I wonder if, had CIVHC had access to and reported numbers for 2015, we might have seen a different report. That is not to discredit the hard work put into the project by the CIVHC or its researchers, but the circumstances are changing, and more rapidly than those numbers imply. By looking at two of the most tumultuous years in HCV treatment history, of course the data they found showed 90% of Coloradans not receiving treatment – everyone was still trying to figure out how to pay for it and pricing agreements had not yet been reached. Hopefully, their next report on the subject will be less doom and gloom, and a bit more reflective of the current treatment landscape in Colorado.

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.


1 Comment

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One response to “More Sad News on the Home Front

  1. Thank you for your kind words about Colorado ADAP. We are proud to have treated over 100 individuals through our prior authorization program, approximately 20% of our co-infected population to date.

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