By: Marcus J. Hopkins, Blogger
In the last post of 2016, we at HEAL Blog will take a look at the stories that presented the greatest issues of the year. While there are still new stories to cover, December presents an interesting challenge, as much of the news and events get swallowed up in the year-end hustle and bustle, as well as the excitement of the various holidays. As such, it serves as an excellent opportunity for reflection upon the year we leave behind, as well as aspirations we may have for the year to come.
In 2016, three main issues have garnered repeated coverage: nominal coverage versus actual access, the financial burden posed by newer Direct Acting Agents (DDAs) to treat Hepatitis C (HCV), and opioid and heroin abuse and overdose. The latter topic was featured or mentioned in no fewer than nineteen post, over the course of 2016, and if mortality and emergent care reports are indicative of any trend, that number is likely to increase in the coming year.
Perhaps the biggest frustration faced by patients is the lack of access to effective, easily tolerated HCV treatments. While most Medicaid, Medicare, AIDS Drug Assistance Programs (ADAPs), and private insurance plans indicate on their formularies and Preferred Drug Lists (PDLs) that they offer coverage for newer DAA HCV drugs, actually gaining access to these drugs is often an exercise in patience, abstinence, and enraging hurdle jumping that leaves many patients in the lurch. Whether it’s waiting for one’s liver to degrade to the right fibrosis score, abstaining from drug and/or alcohol use for a predetermined period, or simply fighting through the various appeals and denials, most patients, regardless of their payer, face an uphill battle to being approved for treatment. Many of these trends were also covered throughout the year in the HIV/HCV Co-Infection Watch.
This type of nominal coverage – indicating that coverage is offered, but approving relative few prescriptions – is largely related to the second major issue of 2016: financial burden. Treating and curing HCV is expensive, though few payers have the flexibility to openly disclose exactly how expensive due to existing trade secrets laws that prevent them from publicly revealing the exact price they pay per drug. Regardless of the various discounts and rebates offered by drug manufacturers, every player has indicated that the price is still too high to remove the draconian Prior Authorization (PA) standards they’ve put in place to open coverage to everyone, regardless of liver degradation or whichever other bullet point they’ve managed to fail. Regardless of how many reports, studies, and analyses are put forth indicating that the short-term high cost of a cure is far less expensive than the longer-term repercussions and various related ailments and costs associated with untreated Chronic HCV, there is little indication from payers that these roadblocks to care will be removed.
Perhaps the most personally onerous barrier amongst these myriad prerequisites is the abstinence measure. With an estimated 60% of new HCV infection being related to Injection Drug Use (IDU), People Who Inject Drugs (PWIDs) are often the most stigmatized and marginalized patients infected with HCV. In fact, the stigma related to IDU HCV infection has been listed as one of the primary social barriers to screening for HCV; the threat of being perceived as a drug abuser by friends, relatives, healthcare professionals, and society at large leaves many people hesitant to be screened for HCV, and that fear is exacerbated by the growing number of opioid-related arrests, overdoses, and deaths reported in the media.
Opioid and heroin abuse and overdoses were, again, mentioned in at least nineteen HEAL Blog entries, underscoring the immensity of the threat that’s facing rural and suburban America. While emergent care and law enforcement agencies are attempting various approaches to making headway in dealing with these issues, many state legislative and executive branches are instead taking a hard line on the issue, relying on outdated and troublesome research, as well as outmoded prejudices and preconceived notions about who is to blame, who is at fault, and how hard to come down upon them.
It doesn’t help that, despite solid research and scientific evidence, current public opinion about how to deal with the crisis has seen a troubling resurgence of blunt force solutions, over nuanced, evidence-based approaches. The prevailing sentiment seen in many of the rural and suburban areas is, “It’s their problem, and if they can’t deal with it, it’s still their problem.” While this line of thinking may provide feelings of moral superiority and indignity, they do not help craft real world solutions, especially when those sentiments become campaign talking points.
Overall, 2016 has been something of a rough year, with less than glowing reports coming from virtually every sector of the HCV advocacy arena. And, if we’re being honest, we face uncertain times in 2017, with many of us watching and waiting for signs that we’re moving in either direction. This is the most frustrating part for virtually all parties involved: we just don’t know what’s next, nor do we know how or for what to prepare. And with that, we bid 2016 adieu.
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.