By: Marcus J. Hopkins, Blogger
Virtually every state in the U.S. is facing mounting – and seemingly insurmountable – costs related to treating Hepatitis C (HCV), and there appears to be little respite in sight, if the growing number of opioid abusers has anything to say about it. More and more often, states are reporting that new waves of HCV are being driven not by the Baby Boomers who once typified the common HCV patient, but by droves of younger, poorer, and whiter heroin and opioid prescription drug abusers.
For those of us who have been following the issue have seen this coming down the pike for well over a decade. As highly effective and powerful prescription opioids became easy to obtain in the late 90s and early 00s, the number of people abusing these drugs took an unsurprising upward tick, as well. While state and Federal governments attempted to quell the problem by tightening the reigns on prescribing and purchasing opioid drugs, they did little to confront the problem of addiction to those drugs. It became easier for addicted patients to leave behind the pricy prescription pills, and obtain the much more readily available and cheaper heroin that was waiting in the wings.
With this wave of new HCV infections, state and federal healthcare programs such as Medicaid and the Ryan White program saw an influx of clients, all of whom health officials are quick to tell you “deserve” to receive adequate treatment for their disease. The fiscal reality of paying for those drugs, however, has been such that Direct Acting Agents (DAAs) for treating HCV have been largely relegated to the treatment of last resort; for those who are the sickest, and whose livers are already significantly scarred. That may be about to change…whether states can afford it, or not.
U.S. District Judge John C. Coughenour recently granted a preliminary injunction on May 27th that requires Washington state’s Health Care Authority to cease a 2015 policy that restricted access to DAA drugs based on a measure of liver scarring in a response to a class-action lawsuit filed on behalf of two clients of Apple Health, Washington’s version of Medicaid. The judge ruled that the state’s requirement was not consistent with existing state and Federal Medicaid requirements that drugs be dispense based on medical need, rather than on degree of sickness.
MaryAnne Lindebald, Washington’s state Medicaid director, is previously stated in a letter to the U.S. Senate that treating all of Washington’s Medicaid patients living with HCV would cost thrice the amount of the budget for the entire Medicaid program, not just the funds allocated to treating the disease. It is unclear when Apple Health clients can begin receiving DAA HCV drugs through Apple Health, but the judge’s ruling ordered all parties to report back in sixty days.
Despite all the good will Merck and Co, Inc. has built up from releasing its much cheaper Zepatier at a $54k Wholesale Acquisition Cost (WAC), the fact is that states are STILL struggling to afford the cost of treatment. Pennsylvania, for example – a state that still restricts access to these drugs based on liver scarring – has seen it’s yearly cost per patient expense more than double since 2013, from $33,734 to $76,425. In the span of two years, the state Department of Human Services’ Medicaid program has seen its bill for HCV drug treatments jump from $33.7 million to $138.1 million (Twedt, 2016). The problem is unlikely to get any more affordable, especially if Pennsylvania removes the liver scarring requirement from barring treatment.
Ultimately, it’s unclear whether or not “market forces” will convince drug manufacturers to lower the prices of their drugs. With so few DAA treatment options currently available (seven, at the time of writing), there’s no real way to measure market effects on HCV pricing, and manufacturers are unabashedly defending the high cost of their products, despite public and professional outcry against them. At some point, however, something will have to give, and unfortunately, the people who will suffer the most will be those who can least afford to do so.
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.