Monthly Archives: December 2017

2017 Year in Review

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

As it tradition for HEAL Blog, the final post for 2017 will be a look back at the topics we’ve covered over the year and a look forward to the future.

2017 Year End, Turning into 2018

Photo Source: AGH University

HEAL Blog releases 50 posts a year (including this post), and those posts fell within one of five categories: Hepatitis Increases, Incarceration, HCV Drug Discussions, Opioids, and Other. Posts related to Hepatitis Increases focused primarily on reports of increased infection/morbidity rates in various states and population, including Hepatitis A, B, and C. Those related to Incarceration focused primarily on increased infection rates and treatment within incarceration settings (prisons, jail, and juvenile detention centers). Posts related to HCV Drug Discussions focused on pricing, availability, and treatment outcomes. Opioid-related posts focused on the toll of the opioid epidemic in the U.S. and the role they play in increasing rates of infection for HIV and Viral Hepatitis (VH). Posts that fell outside of those specific topics are categorized as “Other.” The distribution of those posts are as follows.

  • Hepatitis Increases – 17
  • Incarceration – 4
  • HCV Drug Discussions – 15
  • Opioids – 9
  • Other – 4

As the incidence of Viral Hepatitis infections continues to rise, there are specific patterns – most of the highest rates exists in states that are primarily rural or suburban (with few densely populated metropolitan areas); new Acute Hepatitis C (HCV) diagnoses tend to be in younger populations (ages 18-45) and are increasingly linked to Injection Drug Use (IDU) as the primary risk factor for infection within this age demographic. Prescription opioid abuse and heroin are playing an increasing role in the spread of HCV, not only in America, but across the globe. In the U.S., many of the rural states where HCV rates are exploding are racially and ethnically homogenous (read: primarily Caucasian/White). Despite this, even in states with low numbers of racial and ethnic minorities, African-Americans are disproportionately impacted by HCV infections as a percentage of the population – despite being fewer in number, the percentage of African-Americans infected is higher than other racial and ethnic groups.

In addition to HCV-related infection increases, homeless and indigent populations are facing vast increases in Hepatitis A (HAV) infections, particularly in metropolitan areas where homeless encampments are more densely packed and infections are more easily spread. Arizona, California, and Minnesota have all experienced high rates of HAV within their respective homeless populations, with California facing the highest rates of both morbidity and mortality. California’s HAV crisis is also quickly spreading along the coastline, heading northward. HEAL Blog will continue to monitor the situation.

As for the forecast into 2018…it’s not looking good for the U.S. With the installation of the Trump Administration’s various secretaries and their approach to management and governance, both healthcare advocates and institutional healthcare presences are considerably concerned with the path being laid before us. In addition to concerns about the appointments being made by the Trump Administration (of which there are many concerns, and far fewer appointments), the Legislative Branch’s stewardship under Republican majority in both houses has proven both hostile to the healthcare concerns of Americans, and incredibly clumsy in their attempts to address virtually any issue put before them. Both the Executive and Legislative Branches have inspired little confidence that anyone – healthy or otherwise – are going to come away from their agendas unscathed.

Both branches have, in 2017, created an environment of legislative and administrational chaos and uncertainty, both of which are reflected in the higher increases in health insurance premiums offers on the Affordable Care Act’s (ACA) insurance marketplaces. Between shortened enrollment periods and all-but-eliminated advertising and outreach budgets, enrollment is expected to fall short of its goals for insuring Americans in 2018. Moreover, this type of chaos, unreliability, and unpredictability tend to breed contempt, which may result in Republicans losing their majority in one or both houses during the 2018 midterm elections.

Of significant concern is the Republican Senate’s approach to bill crafting, which has largely been conducted in secret, without input from Democratic lawmakers, and is heavily influenced by the very special interest groups against which many of these politicians campaigned. After failing twice to repeal the ACA in 2017 despite having a majority in both houses, Senate Republicans have repeatedly attempted to cripple the law through various means, the most recent of which involved slipping into their “Tax Reform” bill an effort to repeal the individual mandate provision that requires virtually every American to purchase some sort of qualifying health insurance plan in an effort to stabilize costs once sicker clients entered the market.

In the Administrative Branch, the heads of the various Departments nominated by President Trump have done little to inspire confidence, as well. Tom Price, who was Trump’s initial pick for the Department of Health and Human Services, was forced to resign after reports indicated that he racked up $400,000 in privately chartered flights for personal and professional reasons. This was a significant departure, as previous heads took commercial flights, save for rare exceptions. Now that Price is out of the way, Trump has nominated Alex Azar, a former pharmaceutical company executive whose tenure at Eli Lilly saw a three-fold increase in the cost of the insulin over a ten-year period. Needless to say, it is less than certain that a person who oversaw such price increases will be the “…star for better healthcare and lower drug prices,” as President Trump stated in his tweet announcing his pick for the position.

Given the chaotic and unsteady stewardship of the country, it is hard to express any optimism going forward unless circumstances change dramatically.

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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.

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Colorado Takes Big Step Towards Eradicating HCV

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

The state of Colorado took the enormous first step towards eradicating Hepatitis C (HCV) in the U.S. by lifting HCV treatment requirements for citizens who receive health benefits from the state’s Medicaid program. The move comes after the American Civil Liberties Union (ACLU) of Colorado filed a class-action lawsuit against the state for continuing to ration HCV care for Medicaid patients, and after health officials in the state asked for those restrictions to be removed (Brown, 2017).

ACLU logo

Photo Source: ACLU

The ACLU has been instrumental in winning treatment for patients living with HCV in the country’s incarcerated populations, filing suits against several states’ Departments of Corrections for failing to adequately supply HCV treatment to inmates whose HCV status is known. Inmates are the only Americans who are guaranteed healthcare coverage under the Constitution after a 1976 Supreme Court ruling found that “deliberate indifference” to an inmate’s medical needs constitution “cruel and unusual punishment” under the 8th Amendment (Estelle v. Gamble, 1976).

In both incarceration settings and state Medicaid programs, various hurdles have been put in place that require patients to do extra legwork to gain access to treatment that the programs must offer in order to save money on what were extremely expensive revolutionary HCV Direct Acting Antivirals (DAAs) that effectively cure patients of HCV. The most expensive of these medications, Harvoni (Gilead), has a Wholesale Acquisition Cost (WAC) of $94,500 ($1,125 per pill) for 12 weeks of treatment – the standard regimen length used to achieve Sustained Virologic Response (SVR – “cure”). Since Harvoni’s 2014 release, several new DAAs have come on the market, and after much outcry from patients, advocates, and the U.S. Congress, prices have been driven down. The most recent DAA therapies – Vosevi (Gilead) and Mavyret (AbbVie) – entered the market at $74,760 ($890 per pill for 12 weeks) and $26,400 ($471.42 per pill for 8 weeks) respectively.

Mavyret, AbbVie’s most recent HCV therapy, has the potential to be a financial game changer for state-run healthcare programs that have struggled to ensure that patients receive the treatment they need while not simultaneously destroying their pharmacy budgets to pay for it. That said, WAC costs serve only as a baseline price for any drug that enters the market, after which the various programs and insurers (payors) begin a negotiation process with the drug manufacturers to determine the final cost paid after rebates, pricing agreements, and deductions. The conventional wisdom is, “Well, nobody pays the WAC price.” Unfortunately, these final prices are not readily available to the public, as they fall under existing Trade Secrets laws that prevent the programs from publicly stating the final cost they pay for the drugs.

AbbVie's Mavyret medication

Photo Source: AbbVie

State Medicaid programs have been under considerable fire from HCV advocates, as well as the Department of Health and Human Services (DHHS), who have long stated that Medicaid programs should remove barriers to treatment that have included fibrosis score requirements (“Is the patient’s liver damaged badly enough?”) and abstinence from drugs or alcohol. Colorado’s removal of these barrier to care is a phenomenal first step that should be followed by other state Medicaid programs.

References:

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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.

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International Research Effort Shows U.S. Lags in Interventions

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

Research published in The Lancet Global Health found that the U.S. lags behind other countries in terms of HIV and Hepatitis C (HCV) interventions in drug user populations. The study gathered and analyzed data from peer-reviewed, online, grey literature (government reports, issues papers, theses, dissertations, et cetera) databases, and disseminated data requests via social media and targeted E-mails to international experts (Larney, et al, 2017). The study found that just 93 of 179 countries with evidence of Injection Drug Use (IDU) have some form of needle or Syringe Services Programs (SSPs) available (Steptoe, 2017). This comes after previous reports indicating that the U.S. has fallen behind other first-world peers in the goal of eliminating HCV by 2030 (Kaltwasser, 2017).

Medical technician counting needles.

Photo Source: Daily Beast

SSPs are vital tools in the fight to end the spread of HCV and HIV amongst not only People Who Inject Drugs (PWID), but within the general population, as well. While HCV has been thought to be inefficiently transmitted via sexual intercourse, recent studies have shown an increased risk of sexually transmitted HCV if a patient is co-infected with another Sexually Transmitted Disease (STD) or HIV, has sex with multiple partners, or has rough sex (Centers for Disease Control and Prevention, 2017). This higher transmission risk is especially pronounced among Men who have Sex with Men (MSM).

SSPs are meant to serve as intervention points for PWID, providing not only syryinge exchange services, but access to basic health services such as HIV, STD, HCV, and HBV screening, some clinical services, referrals for disease and addiction treatment, counseling, and referrals for Medication Assisted Treatment (MAT) – currently the most effective method for treating opioid addiction. While many othern Western nations long ago saw the efficacy of these programs in preventing the spread of HIV/AIDS, STDs, and other blood borne illnesses, the U.S. has consistently dragged its feet in implementing this effective harm reduction measure across the nation.

Opposition to SSPs in the U.S. (and elsewhere) consistently rely upon fear-based messaging that imagines droves of drug peddling heroin addicts shambling into town like zombies, leaving in their wake a wasteland of used needles just waiting to be stepped on by unsuspecting children and white suburbanites. Recent HIV outbreaks in rural and suburban areas have convinced states and counties to begin allowing government-funded SSPs to open in areas previously thought unlikely to host such facilities. These are generally operated at and by county health departments and their employees, thought there are no standardized national guidelines on what data they must collect and report.

Other intervention points do exist within various healthcare settings – at routine checkups, visits to emergent care, et cetera – but PWID are a notoriously difficult population to integrate into traditional healthcare continua. Furthermore, few, if any, states have compulsory “opt-out” HCV screening regulations that require healthcare providers to screen for the disease in every setting. These measures would allow emergent care workers (for example) to screen from HCV once overdose victims regain consciousness and are able to provide informed denial of screening. Such compulsory screening would play a vital role in helping to eradicate HCV in the U.S…should it be implemented. Realistically, it likely won’t.

References:

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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.

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