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Rural America Continue to Struggle with Opioid Addiction

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

In 1999, the Centers for Disease Control and Prevention (CDC) reported that drug overdose deaths were higher in metropolitan (urban) areas than in non-metropolitan (suburban/rural) areas – a rate of 6.4 vs. 4.0 (per 100,000). In 2015, that trend has reversed, with non-metropolitan overdose deaths more than quadrupled in number with a rate of 17.0, while metropolitan areas had a rate of 16.2 (CDC, 2017).

From these data we can surmise a few things:

  1. The population in the U.S. did not decrease from 1999 (279 million) to 2015 (321 million);
  2. Despite this population increase (+42 million), the total number of drug overdose deaths has increased exponentially;
Medical technician counting needles.

Photo Source: Daily Beast

So, what changed during this period? According to the American Society of Addiction Medicine, from 1999 to 2008, overdose death rates, sales and substance use disorder treatment admissions related to prescription pain relievers increased in parallel:

  • The overdose death rate in 2008 was nearly four times the 1999 rate;
  • Sales of prescription pain relievers in 2010 were four times those in 1999;
  • Substance use disorder treatment admission rate in 2009 was six times the 1999 rate
  • In 2012, 259 million prescriptions were written for opioids – more than enough to give every American adult their own bottle

Along with these sobering (as it were) statistics, four out of five heroin users started out abusing prescription painkillers. Also, 276,000 adolescents aged 12-17-years-old were current non-medical users (abusers) of prescription pain relievers, with 122,000 having an addition to prescription pain relievers. 21,000 adolescents had used heroin in the past year, and an estimated 5,000 were current heroin users (American Society of Addiction Medicine, 2016)

Essentially, as the rate of prescribing opioids increased over time, so too have the rates of addiction and overdose deaths. That said, the opioid prescribing rate has declined from 2012-2017 and is currently at the lowest level in ten years, from 259 million in 2012 to 191 million in 2017.

Even with this decline, reversing the damage already done is going to take at least a generation to fix, particularly when it comes to adequately addressing opioid and heroin addiction (inclusive of treatment, recovery, and relapses). Moreover, there are vast disagreements in how we, as communities, counties, states, and a nation, should best go about dealing with these issues.

Despite the fact that we have hard scientific data and evidence that certain measures work better than others (e.g. – Harm Reduction measures like Syringe Services Programs (SSPs) and Medication-Assisted Treatment (MAT)), it is difficult to convince elected officials to legalize, authorize, and fund these measures. This is largely due to long-standing, albeit factually inaccurate, objections that SSPs are essentially “enabling” or “condoning” drug use and abuse.

One small town in Washington state – Stanwood – has decided to approach their burgeoning opioid addiction problem like they would a natural disaster, the same way they would mobilize and respond to a landslide or flu epidemic:

…the response to the opioid epidemic is run out of a special emergency operations center, a lot like during the Oso landslide, where representatives from across local government meet every two weeks, including people in charge of everything from firetrucks to the dump (Boiko-Weyrauch, 2018).

The name of this group is the Multi-Agency Coordination group (MAC group), and has seven big, overarching goals which are broken up into manageable steps, like distributing needle cleanup kits and training schoolteachers to recognize trauma and addiction. Police officers enter illegal homeless encampments in wooded areas not to arrest them, but to help link them to drug treatment and housing resources, as well as to provide other assistance, such as food, coffee, and transportation to and from appointments (Boike-Weyrauch).

This approach to policing the opioid epidemic is slowly becoming more popular, but again, convincing states, counties, and local municipalities to adopt this strategy is incredibly difficult due to the long-standing opposition against the use of public resources for these purposes. The concept of treating addiction as a disease, rather than as a crime to be punished isn’t an easy pill to swallow for those who believe that only the individual is responsible for dealing with their health issues; who have abandoned the concept that addressing the welfare, health, and safety of all citizens will lead to greater results than leaving people to their own devices.

As part of the Community Access National Network’s ongoing research, we provide state-by-state analysis of various Harm Reduction measures (e.g. – SSPs, Naloxone Access, and Provider Education Requirements) in our monthly publication, the HIV/HCV Co-Infection Watch. Our October edition can be found here: http://www.tiicann.org/co-infection-watch.html

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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HIV Patients Co-Infected With HCV Face Higher Mortality Rates

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

A ten-year follow-up study has found that people living with HIV who are co-infected with Hepatitis C (HCV) face an increased risk of mortality by 4.3%, even when receiving treatment for HIV (Bender, 2018). The same study found that treatment with HCV Direct-Acting Antivirals (DAAs) resulted in a lower risk of mortality than those whose HCV went untreated, but that the harm caused by HCV still resulted in increased risk.

'Sensational' Hep C Response Rates in HIV Coinfection Trial

Photo Source: medscape.com

One of the primary consequences of untreated HCV infections is damage to the liver – damage that is no immediately repair itself once the virus is successfully treated. Liver fibrosis – scarring of the liver that prevents the organ from properly functioning – is not healed by HCV treatment, and depending upon the severity of the scarring, the liver may never completely regenerate. Those whose livers are cirrhotic – those with late-stage liver scarring – will likely never fully recover optimum liver function and may become dependent upon other prescription medications and dietary restrictions to aid in liver functions such detoxifying substances in the body, purifying blood, and making vital nutrients (Welch, 2017).

This issue is one that receives far less attention than it deserves and is part of why there is so much opposition against including Fibrosis Scoring in treatment determinations. While it may seem financially prudent in the short-term to limit treatment of HCV to those who are “sick enough” to be treated, the long-term negative health impacts of liver scarring are far costlier in the long-term. For those living with HIV, liver function is of critical concern as that is where most HIV medications are metabolized. If liver function is impaired, the drugs may not properly metabolize, making the treatment of HIV less effective.

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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AbbVie’s Mavyret Found Safe and Effective in HIV/HCV Co-Infected Patients

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 analysis of two Phase 3 trials evaluating the safety and efficacy of Mavyret (glecaprevir/pibrentasvir) in patients co-infected with Hepatitis C (HCV) and the HIV-1 virus (the most common form of HIV in the United States) has found that the drug is highly effective and safe for use in treatment (van Paridon, 2018). Using a 12-week regimen to treat patients’ HCV resulted in an overall 98% Sustained Virologic Response (SVR – “cure”) in individuals with or without cirrhosis across genotypes 1-5.

Mavyret

Photo Source: Hep Magazine

A total of 152 patients without cirrhosis received an 8-week regimen, while 16 with cirrhosis received the 12-week regimen. Overall, the SVR across all patients was 98% with no relapses in any HIV/HCV co-infected patients with or without cirrhosis. Those patients without cirrhosis who received 8 weeks of Mavyret resulted in an SVR at 12-weeks post-treatment of 99.3%.

Treatment in HIV/HCV-co-infected patients has been tricky from the beginning in no small part because only Sovaldi (Gilead) served as a useable treatment for patients with HIV, because it had the fewest counterindications with the most commonly prescribed HIV drugs. According to an HIV/HCV drug interaction report prepared this month from HEP Drug Interactions – which can be accessed at the following address – which can be downloaded here – most of the HCV Direct-Acting Antivirals (DAAs) have no negative interactions with the individual component drugs of most HIV regimens. Most of the combination drugs – the single-pill regimens most commonly used to treat HIV for the last decade – do have some counterindication with the DAAs…except for Sovaldi (sofosbuvir). Gilead’s other sofosbuvir combinations – Harvoni, Epclusa, and Vosevi – seem to have a greater chance at interacting negatively.

Zepatier (Merck) is a prime example of the aforementioned prescribing circumstance: it works well with individual drug components, but with only one HIV combination drug – Biktarvy (Gilead). Biktarvy is Gilead’s newest HIV regimen and is not yet widely prescribed, though it is recommended as one of the initial regimens for most people with HIV (AIDSinfo, 2018). Zepatier, itself, is only good in treating HCV Genotypes 1 and 4, while Epclusa and Mavyret are pangenotypic (meaning they can be used to treat Genotypes 1-6).

At any rate, HIV patients who are co-infected with HCV are gaining more treatment options as newer drugs are released, which is always a good thing; and, as more regimens emerge, perhaps there will be fewer interactions in the future .

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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Veterans Affairs Department Provides Reliable Proving Ground for HCV Treatment

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 Veterans Health Administration (V.A.) is one of the most frequently and vocally derided health systems in America. Since its inception in 1930, the V.A. has been plagued by scandal, fraud, malpractice, and quality of care issues. There has been no single decade since 1930 when the V.A. hasn’t faced some sort of scandal, whether it be massive oversights in patient care, exorbitant wait times just to be seen, squalid facilities, or infection outbreaks. One Veteran said to me, during an exchange, “The V.A. can’t get good doctors in there, because nobody wants to be associated with the V.A.” Realistically, the V.A. has earned its poor reputation through decades of mismanagement, underfunding, understaffing, and inconvenient locations. Furthermore, every President since Franklin D. Roosevelt has promised to fix, once and for all, the V.A. health system. None have managed to do so, in whole.

Logo: U.S. Department of Veterans Affairs

Source: U.S. Department of Veterans Affairs

But, it’s not all bad. Improvements, though incremental and rarely immediate, have been made, and there are areas where the V.A. performs brilliantly. Perhaps the best example of this is how the V.A. has dealt with Hepatitis C (HCV) within Veteran populations.

In March of 2016, the V.A. announced that it would be expanding coverage for HCV treatment using Direct-Acting Antivirals (DAAs) to all Veterans in its health system who have the virus regardless of their disease stage (Kime, 2016). Since that time, the V.A. has proven to be the most successful public or private health system in the U.S. for screening, testing, treating, and curing HCV. More importantly, they achieve this not by limiting care to the sickest, but by opening access to the cure for HCV to all members.

As of June 2018, 83.5% of the V.A. Birth Cohort (those born between 1945-1965) have been screened and received HCV testing (U.S. Department of Veterans Affairs, 2018). Since 2014, the V.A. has treated 110,220 (through June 2018), and an average of 323 Veterans are starting treatment every week. The cure rates with all oral DAA therapies is 95%. These statistics are phenomenal, and if they were to be replicated in every healthcare setting, we could likely beat the World Health Organization’s 2030 target for HCV elimination a year or so early. We likely won’treplicate the V.A.’s success in other programs, but that’s a whole other kettle of fish.

So, what does all of this success mean for everyone else? Well, because of the nature of the V.A., all of the data collected are an excellent source of…well, data for other researchers to use for the purposes of making retrospective analyses to assess the risks and benefits of modern HCV therapies (May, 2018). Essentially, because the V.A. has provided treatment using every HCV DAA available, we have a broad base of knowledge to do comparative analyses of efficacy between the various DAAs and across various age, race, and health demographics.

While the V.A. does have serious problems to correct, they are doing a lot of things “right.” HCV – the most fatal disease in the U.S. – just happens to be one of those.

References:

  • Unites States Department of Veterans Affairs. (2018, August). Hepatitis C Virus (HCV) VA IS A NATIONAL LEADER IN HEPATITIS C TESTING, CARE, AND TREATMENT. Washington, DC: United States Department of Veterans Affairs: Office of Public Affairs: Media Relations. Retrieved from: https://www.hepatitis.va.gov/pdf/VA-HCV-Fact-Sheet.pdf

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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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Washington State Unveils New Effort to Eliminate HCV by 2030

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

Washington state Governor Jay Inslee signed a directive on September 28th, 2018 that directs state agencies, tribal governments, and other local public health officials to coordinate on a strategy to eliminate the Hepatitis C Virus (HCV) from the state by 2030 (Pacheco-Flores, 2018). This is the first state-led effort in the U.S. to attempt to achieve the 2030 elimination goal set forth by the World Health Organization (WHO) in May 2016.

Gov. Jay Inslee

Photo Source: Spokesman.com (AP Photo/The Olympian, Tony Overman)

Inslee announced this directive at a news conference at Harborview Medical Center in Seattle explaining that the approach uses a combination of increased and expanded prevention screening and increased access to HCV Direct-Acting Antivirals (DAAs) that serve as a functional cure for the disease. Officials estimate that there are 65,000 people living with HCV in Washington state.

There is also a money-saving aspect to this plan that would involve pooling together multiple state departments with purchasing power for drugs (e.g. – Department of Corrections and Department of Social and Health Services). This method, which will also soon be employed in Massachusetts, would allow the state to pull funds into a general purchasing fund to purchase the drugs in bulk at a lower cost-per-capita. This is particularly useful given the relatively recent introduction of lower-priced DAAs such as AbbVie’s Mavyret that have lowered the cost of treatment-per-patient significantly since the initial introduction of DAAs in 2013.

One of the biggest barriers to elimination is going to be the screening/testing apparatus and implementation component. The majority of Washingtonians (and, in fact, all Americans) are unaware that they are infected with HCV, in no small part because there have been few properly funded efforts to adequately screen and test for the disease. While the rapid testing kits are relatively cheap, confirmatory blood testing and genotyping are considerably more expensive. As the directive was only just signed, there are few details about how these procurement and payment processes are going to work. Realistically, given the emerging demographics of new HCV infections nationwide – younger, poorer, and potentially drug-addicted, it is safe to assume that a large swath of those living with HCV may not possess the financial resources to afford to pay for these services. Is the state going to pay for those who cannot afford it? (Likely, not.)

Beyond just cost-related issues, it has been difficult, given the structure of the American healthcare model and funding, to ensure that high-risk demographic groups such as the homeless, rural populations, and People Who Inject Drugs (PWIDs) receive the proper amount of focus they deserve. These populations are notoriously difficult to engage in even basic healthcare services, much less preventative testing and follow-up care.

At the 2017 International AIDS Society conference in Paris, an Australian researcher and provider, when speaking of reaching rural populations stated, “It’s just not that hard.” In nations with universal healthcare, it ISN’T that hard to do proper outreach into these communities, because there’s no question of who will pay for it. In the backward, hackneyed U.S. healthcare system, however, “Who’s going to pay for this,” is a legitimate barrier to doing outreach. Without a specified payor lined up, there is no guarantee that there will be funds to pay for services either from the patients, from the state, or from private insurers. And the sad reality of the U.S. healthcare system is that the best of the suboptimal care is reserved for those who can afford it.

So, while Governor Inslee has taken a great first step, he must work to ensure that the initiative is adequately funded with the presumption that 80%+ of those who need services will be unable to personally pay for them.

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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Gilead Sciences Announces Authorize Hep C Generics for the U.S.

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

Gilead Sciences, makers of the breakthrough Hepatitis C (HCV) drugs, Sovaldi, Harvoni, Epclusa, and Vosevi, have announced that they will be releasing authorized generic versions of its two most popular drugs, Harvoni and Epclusa, in the United States (Hee Han, 2018). The drugs will be introduced into the U.S. market beginning in January 2019 at a list price of $24,000.

Gilead

If this seems counterintuitive to Gilead’s business model, consider the following: their most recent drug for treatment-naïve patients, Epclusa, was released in 2016 at a Wholesale Acquisition Cost (WAC) of $74,760 for a 12-week regimen or $890 per pill. In 2017, Merck introduced its own pangenotypic drug, Mavyret, at $39,600 for a 12-week regimen, with the recommended dosage for most patients being eight weeks at $26,400. Essentially, Merck came in at a little over 1/3 the cost of Gilead’s pangenotypic drug and became the fastest adopted drug for both Medicaid programs and AIDS Drug Assistance Programs (ADAPs) in just four months (Hopkins, 2018).

This decision comes on the heels of a rough couple of years for Gilead’s HCV market. The company managed to weather near-unrelenting attacks following the October 2014 release of Harvoni at a WAC of $94,500, quickly dubbed “The $1,000 Pill” by media outlets and advocates who were outraged at what they considered to be an outlandish price point despite the medication’s efficacy. So great was the furor that Congress convened hearings on the matter, reigniting the smoldering embers of rage against pharmaceutical company drug pricing. The optics weren’t great for Gilead, but despite that, Gilead’s stock price and profits skyrocketed as they essentially cornered the growing HCV market both in the U.S. and abroad.

Generic pill capsule

Photo Source: Forbes

Gilead is no stranger to authorized generics. Four years ago, Gilead struck a deal with seven Indian pharmaceutical manufacturers to develop authorized generics to be sold in poor countries roughly $10 per pill, roughly 1% of the U.S. list price (Harris, 2014). This further enraged Western critics who accused Gilead of price gouging. Gilead’s response, at the time, was that they were only charging “…what the market could bear.” Essentially, they were price gouging with the understanding that, regardless of the list price or any pricing negotiations, rebates, or 340B pricing, they were going to dominate the HCV treatment market with their superior product, and the U.S. healthcare system had no real systems in place to combat them.

In 2018, private insurers and public payors alike have quickly switched their preferred drug over to Mavyret from Epclusa. With the introduction of the similarly priced generics from Gilead in 2019, depending upon the uptake by insurers and public payors, it could potentially mean that Gilead could recapture lost ground in the HCV drug marketplace…assuming that other pharmaceutical companies don’t follow suit (they might).

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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3rd Annual National Monitoring Report on HIV/HCV Co-Infection Recap

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 Community Access National Network (CANN) hosted its 3rdAnnual National Monitoring Report on HIV/HCV Co-Infection on Wednesday, September 19th in Washington, DC, at PhRMA Headquarters. Presenters included Marcus  J. Hopkins (the author), Amanda Bowes (National Alliance of State and Territorial AIDS Directors – NASTAD), Jack Rollins (National Association of Medicaid Directors), and Ayesha Azam (Patient Access Network – PAN – Foundation).

HIV/HCV Co-Infection Watch

HIV/HCV Co-Infection Watch

I presented on the progress that’s been made in expanding access to Hepatitis C (HCV) Direct-Acting Antivirals (DAAs) in state Ryan White AIDS Drug Assistance Programs (ADAPs), Medicaid programs, and the Veterans Administration. In addition, I discussed some of the issues facing Harm Reduction measures (e.g. – Syringe Services Programs, Doctor Shopping laws, Prescriber Education requirements, et cetera), as well as CANN’s foray into Correctional Healthcare.

One key finding is that, as of September 2018, 39 state ADAP programs (most recently, Mississippi) have expanded their formularies to include coverage for HCV DAAs. By comparison, when the HIV/HCV Co-Infection Watch (CANN’s monthly report) began in January 2015, only 7 states offered expanded coverage. In addition, on the correctional healthcare front, there are currently at least 16 HCV-related lawsuits active in 14 states.

You can find my presentation at the following link:

Amanda Bowes, a Manager on NASTAD’s Health Care Access Team, presented on NASTAD’s work with Ryan White programs to expand access to treatment, as well as previewing a forthcoming PDF and web-based consultation tool – “Strategies to Increase Access to Hepatitis C (HCV) Treatment within ADAPs: Provider Decision Tree”– for providers to consult when determining how their patients living with HCV can pay for treatment.

In addition to this fantastic resource, Amanda also presented statistics about HIV/HCV Co-Infection within Ryan White programs. In calendar year 2016, over 1,000 (2%) across 15 ADAPs were reported as being co-infected with HCV at some point during the year. Of those, 336 (32%) of these clients received treatment for their HCV, and of those who were treated, 160 (48%) were reported as cured.

You can find Amanda’s presentation at the following link:

Jack Rollins, Senior Policy Analyst with the National Association of Medicaid Directors, presented on some of the opportunities to lower the costs of prescription drugs within state Medicaid programs. One of the most popular methods of controlling prescription in European markets is through the use Value-Based Purchasing (VBP), a concept that the U.S. has been loath to adopt in our traditional Fee-For-Service healthcare market.

The general idea behind “Value-Based Purchasing” (at least in nations with universal healthcare) is that purchasers – the buyer of the drugs prior to distributing them to patients – pay for drugs only when they prove “effective.” As that relates to HCV, the payor would only pay for the cost of the DAA if the patient achieves Sustained Virologic Response (SVR) – if the patient is cured of HCV.

VBP, as it’s currently being discussed in the U.S., looks much different. Currently, Oklahoma is the only state whose Medicaid program has an approved VBP, but the details of that are largely unavailable to the public due to existing trade secrets laws – a consistent sticking point with healthcare advocates that allows pharmaceutical companies and payors to “hide” the actual cost of medications.

Jack also mentioned two more states, Louisiana and Massachusetts, the latter of which recently had their VBP proposal denied by the Centers for Medicare and Medicaid Services (CMS). Massachusetts’s proposal was proposed to be limited in scope, proposing limited coverage for certain therapeutic drug classes with a robust exceptions process and would be tied to coverage decisions made by a Pharmacy Benefits Manager (PBM) and/or state employee benefits. Although this proposal was denied by CMS, several other states are interested in this idea.

Louisiana is looking at VBP policies specifically targeted at HCV DAA drugs, terming it the “Netflix for HCV.” Their idea would pool Medicaid and state Corrections populations under a model that would pay a flat amount to a drug manufacturer (say, Gilead) in exchange for unlimited access to their drug (say, Gilead’s Epclusa). Essentially, Louisiana would play a flat fee and be able to prescribe as much (or as little) of the drug as needed to treat patients and inmates with HCV.

You can find Jack’s presentation at the following link:

Ayesha Azam, Senior Director of Medical Affairs at the PAN Foundation, presented on the important of Co-Pay Assistance in underinsured populations. In defining who is considered “underinsured,” PAN goes by the following descriptors:

  • Individuals who spend more than 10% of their annual income on out-of-pocket medical expenses
  • Individuals who spend more than 5% of their annual income on deductibles
  • Individuals whose income is less than 200% of the Federal Poverty Level and medical expenses are greater than 5% of annual income
  • Seniors who do not have funds or who fall into the “donut hole” (where they have outspent their annual benefit, but have not reached the Medicare catastrophic coverage level)

So, using those descriptions, I’ll present my own information:

My health insurance through Highmark West Virginia BlueCross/BlueShield has a deductible of $4,000, which for me is around 12% of my annual income. My Out-of-Pocket Maximum is $5,000, around 15% of my annual income. With that in mind, let’s look at my Out-of-Pocket costs for the first quarter of 2018:

Doctor Visit Co-Pays (01/18 – 03/18): $246.34

Blood Work (single visit on 02/06/18): $1,785.00

HIV Meds (01/18 – 03/18): $768.00

Endoscopy (02/28/18): $278.68

Anesthesia (02/28/18): $440.50

TOTAL: $3,518.02

Add on a couple more months of the medications, and another volley of blood work in June, and I’ve hit both my deductible AND my out-of-pocket maximum before I’ve ever reached half-way through the year.

Using PAN’s definitions, I am critically underinsured; what’s worse is that the vast majority of plans made available through West Virginia’s health insurance marketplace are shifting further towards high deductible plans that tack on co-insurance after the deductible has been met (mine is 10% co-insurance), and I’m looking at spending nearly 1/3 of my annual income justfor my healthcare.

Without the West Virginia Ryan White Program, I would likely be so far underwater with medical bills (which I am), that I couldn’t even see to swim to the surface. Worse, still, is that, for HCV patients, there is noRyan White-type program to provide them with that level of financial assistance, leaving them to essentially fend for themselves.

This is where organizations like the PAN Foundation step in with Patient Assistance Programs (PAPs). In order to qualify for assistance with PAN, a client must be underinsured and make below 400%-500% (depending upon the fund-specific guidelines) of the Federal Poverty Level (FPL). PAN receives specific funding streams for individual conditions (e.g. – HIV, HCV, diabetes, arthritis, et cetera) and assist with the out-of-pocket costs associated with treatment. They will assist with Co-Pays, Travel to and from doctor appointments, and Insurance Premium payments.

The downside is that the demand for this assistance far outstrips the supply, and because each condition/disease has a specific funding stream, each fund has its own number of clients that can be helped before funds are exhausted. With most HCV drugs be shunted into Specialty Tiers, co-pays for each fill can be $250+ depending upon the insurance plan. To be clear – one member of the PAN Foundation stated, recently, that research indicates any co-pay over $50 to be “unreasonable.” Using that analysis, a single visit to my HIV doctor will set me back $60+, depending upon whether or not I’m assessed a clinic fee on top of my specialist co-pay.

This is where PAN Foundation (and other charitable assistance programs) are vital. Moreover, the vast majority of patients in the U.S. – already a low-healthcare-literacy nation – have no idea that these resources exist, which is a mixed blessing, for PAN: fewer patients knowing about the program means that funds will not be so quickly exhausted; the other side of that coin is that fewer patients will receive the critical financial assistance they need.

You can find Ayesha’s presentation at the following link:

 

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