Tag Archives: HCV infection

A Conversation About HCV in Incarcerated and Post-Incarceration Settings

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

On Thursday, May 11th, the Community Access National Network (CANN) hosted a Community Roundtable on Linkages to Care for Current/Former Incarcerated Citizens Living with Hepatitis C (HCV). Three speakers, including myself, gave presentations detailing the various barriers, opportunities, and complications that surround ensuring that incarcerated citizens receive the car to which they are legally entitled under the 8th Amendment’s “…cruel and unusual punishment” provision.

State/Federal HCV-Related Lawsuits Involving Prisons (2007-2017). At least 18 Class-Action and Civil Rights Action lawsuits were filed in 11 states between 2007-2017.

My presentation covered the legal aspect of treating HCV in prisons and jails, much of which I detailed in last week’s HEAL Blog; as such, I will spend this blog discussing the information presented by my peers:

Wayne Turner, Senior Attorney with the National Health Law Program, delivered an excellent and thorough explanation of how Medicaid-eligible incarcerated persons can have their treatment paid for through the Medicaid program if they are taken to an outside facility for care. What this means is that, using a provision written into the Medicaid law, so long as the prisoner is treated at a hospital outside of their incarceration facility, their treatment and care can be covered and paid for through the Medicaid program, rather than relying upon the prison healthcare and pharmacy budgets.

This has the potential to be a hugely beneficial resource for prisons, as treating HCV is very costly. It also raises an interesting question – would this mean that prisoners can be taken to hospitals, be prescribed one of the new Direct Acting Agents (DAAs) to treat their HCV at the hospital, and fill that prescription at the hospital pharmacy and have the drug covered by Medicaid, rather than the prison pharmacy budget? It’s an interesting question, and could be the solution needed to ensure that inmates receive the care they need.

A. Toni Young, President and CEO of the Community Education Group, also delivered a rousing call to action, discussing her work in trying to figure out how to improve access to Medicaid and HCV education both inside the prison system and for the general population. What this really requires, she posits, is that medical professionals as well as Federal, state, and local governments dramatically increase education campaigns to teach people about HCV, and most importantly, how to avoid contracting the disease, both inside and outside of prison settings.

What makes this approach vitally important is that HCV education is something that is sorely lacking in the areas that are hardest hit; not just HCV education, really – healthcare literacy in general is an issue. As such, we must, as Toni suggested, work on ways to get people to actually care about what we’re trying to teach; get them to understand that learning about and preventing the spread of HCV will save their lives.

Another fantastic point brought to the fore by Elizabeth Paukstis, Public Policy Director at the National Viral Hepatitis Roundtable, was that, despite advocates calls for prisons to treat everyone, the reality is stark – the budgets are what they are, and no matter how often or loudly we insist that they treat inmates with HCV, many states simply do not have the resources to do. At that point, litigation is really the only route that many inmates can take to ensure that they receive treatment.

This Community Roundtable was a fantastic event, and I look forward to participating in future roundtables to figure out the best ways in which we can help combat the HCV epidemic.

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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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Widening HCV Epidemic in Wisconsin

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 Wisconsin has a Hepatitis C (HCV) problem; one that’s not going away, and is no longer affecting only the Baby Boomer birth cohort. In 2006, 2,355 new cases of HCV were reported by the state; in 2013, that number rose 12% to 2,638; between 2013 and 2015, the number of new HCV infections rose 42% to 3,745 in a span of only two years (Wisconsin Department of Health Services (WI DHS), 2016b).

While the incidence (the number of new cases) seems relatively low, relative to the population, it is important to remember that these numbers represent only the confirmed cases of HCV infection. Health officials estimate that there are roughly 90,000 people living with HCV in Wisconsin, 75% of whom have no idea they’re infected (Madden, 2017).

Wisconsin Department of Health Services

Photo Source: State of Wisconsin

More troubling than just the massive two-year-increase in new infections is the relatively new trend of new HCV infections amongst people aged 15-29. In the past ten years, reports of HCV have shifted from a single peak of middle age adults in 2006, to a distribution of two peaks in 2015 (Wisconsin Department of Health Services, 2016a). While the increased rate of HCV among older adults is likely the result of a new recommendation to screen the birth cohort, the new peak in infection rates among 15-29-year-olds is likely due to the vast increase in the abuse of prescription opioids and heroin in rural and suburban areas. Between 2011 and 2015, the rate of HCV infection in 15-29-year-olds increased from 40.4 per 100,000 people (2011) to 86.9 per 100,000 people (2015) (WI DHS, 2016b).

Not far behind them are those aged 30-49, with a rate of 74.8 per 100,000 (2015), up from 57.9 per 100,000 (2011), again, largely due to the increase in Injection Drug Use (IDU). It is estimated that 50% of People Who Inject Drugs (PWIDs) become infected with HCV within five years of injecting (WI DHS 2016b). Strong prescription opioids have been readily available via legitimate prescriptions since the mid-1990s to treat virtually any type of pain, during which time, prescription abuse has become a major issue amongst children and teens who gain access and become addicted to these drugs through either their own pain-related legitimate prescriptions, or through illegally obtaining prescriptions written for family members or friends.

While the prescription opioid addiction crisis has been endured for over twenty years, now, only recently have drug manufacturers – such as Perdue Pharma, maker of OxyContin and Opana, the two most widely abused opioid drugs in the U.S. – been called to account for both the addictive nature of their drugs and the oftentimes extraneous supply of medications being routed through local and family-owned pharmacies that often lack the same level of scrutiny and oversight needed to effectively combat over-prescribing and abuse. Wisconsin also does not current require a physical exam for patients to be prescribed opioid painkillers, nor is ID required for all opioid prescription purchases (HIV/HCV Co-Infection Watch, 2017).

Wisconsin also has no doctor shopping laws on the books – laws preventing patients from seeking prescriptions from multiple physicians – which limits the state’s ability to crack down on patients who attempt to gain prescriptions from various sources, as well as prescribers who are lax in their monitoring of patient behaviors. In conjunction with the latter, Wisconsin physicians and pharmacists are not required by the state to undergo mandatory education regarding appropriate opioid prescribing practices in order to ensure that they do not over-prescribe, and that they are prescribing opioids only for medically necessary reasons (HIV/HCV Co-Infection Watch, 2017).

While Wisconsin is certainly not experiencing HCV infection rates as high as other Midwestern and Southern states, such as Indiana, Kentucky, Ohio, Tennessee, or West Virginia, this relatively sudden increase in rates and new infections is troubling. We, here at HEAL Blog, will continue to monitor the situation as it develops.

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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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2016 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

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.

2017 pushing 2016 down

Photo Source: Fotolia by Adobe

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.
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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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Pre-Requisite Treatment Standards Still Abound

By: Marcus J. Hopkins, Blogger

Remember that time when county health officials refused medical treatment coverage to people living with HIV if they were drug users and openly admitted it in a radio interview? Yeah…me, either. This was, however, the case on August 24th, 2016, when Dr. Hal Lee, Los Angeles County Health Services’ Chief Medical Officer and liver specialist, freely admitted to the practice with the following statement:

It’s our obligation to offer treatment in a manner that’s rational and logical. We identify the individuals for initial treatment right now, based on how we can offer the most care to the most people, who are going to benefit from it the most now. We believe it is likely that patients who are not using drugs are more likely to complete the treatment than people who are actively using illicit drugs (Plevin, 2016).

This policy is in direct conflict with the Medi-Cal – California’s Medicaid program – Treatment Policy for the Management of Chronic Hepatitis C, a set of guidelines that went into effect on July 1st, 2015, well over a year prior to the date of this interview (State of California, 2015). What makes Yee’s statement ironic is that Medi-Cal is very likely the agency that would be paying for the services that his office is failing to provide.

In this interview, the reporter states that Yee has developed a checklist of criteria to determine if patients are eligible for treatment – one that apparently disregards the very specific checklist put forth by the State of California. One of the criteria requires patients to be free of drug use for six months prior to receiving Hepatitis C medications.

To bring this further into focus, Health Services, which provides health care for about a half-million low-income Los Angelinos, has approved treatment for only 160 people, as of the beginning of August. By comparison, San Francisco Health Network, which serves only 65,000 people overall, treated 631 people by late June 2016. This is a stark difference in treatment approaches, and speaks, I believe, to the social and socioeconomic stratification that exists in Los Angeles County.

My own experiences with L.A. County’s Health Department left much to be desired. As someone who has relocated to several states and been the beneficiary of their respective health agencies, my experiences within L.A.’s low-income health care programs presented a stark and sad reflection of how L.A. treats its residents who don’t reside in the best zip codes.

Hospitals were run essentially like prisons, with barred windows, numerous metal detectors, and employees who behaved more like judgmental prison workers, rather than health care professionals. Facilities were overcrowded, parking was nearly impossible to find, and locations were so far-flung that taking public transportation to them would take hours. After enduring hours-long commutes on the 5 and 405 freeways just to get to an appointment, I finally gave up on the County program and switched my treatment facility to the AIDS Healthcare Foundation in Van Nuys.

Just beyond the Sepulveda Pass in “The Valley” (San Fernando, that is), this facility that catered to low-income patients was in the right zip code. Though small, it was rarely crowded, focused solely on patients with HIV, and the employees treated everyone, regardless of their mental or physical state, without judgment. There were no metal detectors or barred windows; just good healthcare providers.

Dr. Hal Lee

Photo Source: L.A. Care Consult

What makes me sad about the interview with Dr. Yee is the following quote:

If 70 percent of individuals would live out their lives without any consequences of their hepatitis C infection, none of those people will benefit from treatment. I know that if you come talk to me in one year, in five years, in ten years, you’re going to see these numbers climb, because we’ve put in infrastructure that I know allows us to provide the kind of care that other counties can’t even begin to think about.

Make no mistake – Yee’s approach to treatment is not only outside of California’s long-established treatment guidelines, they are also part of a greater issue: the belief that not everyone is deserving of treatment; that some patients are just “better” than others; that one’s station in life makes them more deserving of quality healthcare.

This interview with not just a county healthcare employee, but the Chief Medical Officer, is a sad reminder of how some doctors fail to live up to their obligations to their patients in a nation where healthcare is not considered a human right. Opponents of Universal/Single-Payer Healthcare love to bandy about the boogieman of “Death Panels,” failing to see that those types of panels already exist, right here in our United States.
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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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Rhode Island Reports Explosion of Chronic HCV, Injection Drug Use

By: Marcus J. Hopkins, Blogger

A new report from the Rhode Island Public Health Institute at Brown University found that the state is currently in the midst of a steep rise in chronic Hepatitis C (HCV) infections, as well as in opioid dependence and overdose. Referred to in the report as a “syndemic,” the study paints a grim picture for the densely populated New England state.

Report Cover: Epidemiological Profile: The Hepatitis C Epidemic in Rhode Island

Photo Source: Rhode Island Department of Health

The study found a 500% increase in HCV-related deaths in the state; it also estimated a prevalence rate of 3.7% – 6%, suggesting that the HCV disease burden – the impact of a health problem as measured by financial cost, mortality, morbidity, or other indicators – may be higher than the state previously estimated. Additionally, Rhode Island’s Medicaid program reporting data suggests that 13,000 Medicaid beneficiaries were screened for HCV in 2014 and 2015; of those beneficiaries, approximately 1,700 returned HCV-positive test results in 2014 and 2015, though it is unknown if all of those individuals sought treatment for their diagnoses. Medicaid reported financing treatment for 215 Medicaid beneficiaries in 2015.

As it relates to last week’s HEAL Blog (HCV in prison populations), the Rhode Island Department of Correction (RIDOC) reported that the prevalence rate for inmates screened for HCV is 17%, and have responded with increased screening, treatment, and cure efforts in the last year.

This new report also indicates that opioid addition and overdose is on the rise within the state, ranking 6th in the nation for drug overdose deaths, the highest in New England. More concerning, perhaps, than the fata overdose rate is that of the non-fatal – at least five times as many non-fatal drug overdoses were reported, which suggests a high level of drug dependence in a relatively small, but densely packed state.

New England, as a whole, continues to battle a growing opioid addiction and overdose epidemic, particularly in the rural and suburban parts of the states – areas which had previously managed to be largely unaffected by the ravages of drug abuse. This trend is reflective of the opioid epidemic in most of the country, and speak to a larger national opioid abuse issue that Federal, state, and local governments are desperate to adequately address.

On the national front, efforts to tighten regulations on prescription opioid drugs face considerable pushback from pharmaceutical manufacturers, whose political sway has largely paralyzed regulatory bodies in their attempts to move forward on the issue. That said, the FY2017 budget currently working its way through the House and Senate includes a significant increase in funds to various programs directed at combating opioid abuse. There has been some movement on efforts to lift the blanket ban on Federal funding for syringe exchange programs, a harm reduction method proven to decrease the spread of blood borne infections, such as HIV and HCV, within Injection Drug User (IDU) populations.

At the state level, Rhode Island’s sole syringe exchange program, ENCORE (Education, Needle Exchange, Counseling, Outreach, and REferrals), is an anonymous program that can provide any individual over the age of 18 with safer sex materials, including clean syringes, bleach, alcohol swabs, cookers, and cotton, as well as condoms. ENCORE outreach workers can also provide anonymous HIV testing, referrals to drug treatment programs, medical care, and social services, as well as clothing and personal hygiene items. The program is located in Providence, RI, and information can be found at http://www.aidscareos.org/.
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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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Intersection of Imprisonment and Healthcare

By: Marcus J. Hopkins, Blogger

“Nearly forty years ago, the U.S. Supreme Court ruled in Estelle v. Gamble that ignoring a prisoner’s serious medical needs can amount to cruel and unusual punishment, noting that “[a]n inmate must rely on prison authorities to treat his medical needs; if the authorities fail to do so, those needs will not be met. In the worst cases, such a failure may actually produce physical torture or a lingering death[.] … In less serious cases, denial of medical care may result in pain and suffering which no one suggests would serve any penological purpose” (American Civil Liberties Union, n.d.)

 

These words put forth in a Supreme Court ruling are vitally important in today’s society – one in which the Centers for Disease Control and Prevention (CDC) released its first ever National Survey of Prison Health Care, the results of which were rosy on the surface, but admittedly (on their part) limited in scope, because they only asked if the service was available, rather than checked to see if the services were actually delivered. In addition, numerous reports at the 2016 International AIDS Conference in Durban, South Africa point to a serious issue brewing in the world’s prisons, as the “War on Drugs,” mass incarceration of drug users, and the failure to provide proven harm reduction and treatment strategies has led to high levels of HIV, tuberculosis, and hepatitis B and C infection among prisoners—far higher than in the general population (Medical Express, 2016).

Two hands holding prison bars

Photo Source: News Limited

The U.S. is exceptional, when it comes to the number of inmates in prison for drug offenses: of the 182,924 inmates currently in Federal prison, 84,746 (46.3%) of them were there for drug-related offenses (Federal Bureau of Prisons, 2016). There are roughly 5 million drug-related arrests each year (Prison Policy Initiative, 2016), all of whom spend some portion of their time going in and out of the jail or prison population, which increases the risk of exposure to blood borne pathogens such a HIV, Hepatitis C (HCV), Hepatitis B (HBV), and Tuberculosis (TB) exponentially over that of the general population. As Injection Drug Users (IDUs) represent an ever-increasing percentage of new HCV infections in the U.S. and around the world, the risk of transmission amongst prison populations is an incredibly serious issue that needs to not only be watched, but addressed.

The unfortunate intersection of imprisonment and healthcare statistics is the reality of the HCV treatment landscape in our nation’s prisons. This has been brought into sharp focus, recently, by a Federal lawsuit against state prison officials in Tennessee, which asks the courts to force the state to start treating all inmates who have HCV (WBIR, 2016).. The Tennessean (part of USA Today) released a report in May 2016 finding that only 8 of the 3,487 inmates known to have HCV were being treated for the disease (Tennessean, 2016) – treatment to which these patients are constitutionally guaranteed, but for which few are ever approved. Further complicating the issue is that the number of HCV-infected inmates is likely much higher, but only a handful are ever tested, because “…acknowledging inmates have the disease means they must treat it.”

The lawsuit in Tennessee is just the latest in a string of Federal and class action lawsuits filed against state and Federal prisons over access to HCV drugs, which similar suits being filed in Pennsylvania, Massachusetts, and other states. Failure to adequately screen and treat all incoming patients for infectious diseases such as HIV and HCV is, in this writer’s opinion, a gross dereliction of duty on the part of prison officials that risks not only prison populations, but to all citizens at large, once those prisoners are released into general population. HIV and HCV that goes untreated is not only likelier to result to much more costly long-term health complications (and potentially death), but is also likely to result in greater overall infection rates, as untreated diseases are more easily spread from person to person.
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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 Receives FDA Approval for Viekira XR

By: Marcus J. Hopkins, Blogger

AbbVie, the makers of the Hepatitis C (HCV) Direct Acting Agent (DAA) drug regimen, Viekira Pak, have received final approval from the Food and Drug Administration (FDA) for their new combination regimen, Viekira XR. The move by AbbVie provides patients with a simpler regimen to follow, in the hopes of increasing regimen compliance.

Stamp marked, "Approved" next to the initial, "FDA"

Photo Source: 3Dprint.com

The chief complaints about the AbbVie regimens from physicians and patients, alike, have been the use of multiple individual component pills – four with the original Viekira Pak, three with Technivie, and now, three with Viekira XR – as well as the dosing guidelines, which require pills to be taken at different times of the day in order to maintain consistent levels of the drug in the body. These complaints hearken back to similar complaints made about multi-pill regimens used to treat HIV, that required multiple doses per day. Regimen compliance with multi-pill regimens is thought to be lower, because patients report feeling more burdened by having to stop what they’re doing, multiple times per day, in order to take their meds. This argument seems to hold sway, as many of the newest regimens for both HIV and HCV are single-pill regimens (occasionally boosted by a second pill), which require far less effort on the part of busy patients. Viekira XR responds to this by simplifying the regimen down to a once-daily dose of one pill containing ombitasvir, paritaprevir, and ritonavir, and a second pill containing dasabuvir.

Like Viekira Pak, Viekira XR is designed for use in patients living with HCV Genotypes 1a and 1b. Technivie, which has all of the same components as Viekira Pak minus the dasabuvir, is for use in patients with HCV Genotype 4, and was the first DAA drug that was specifically used for that genotype. AbbVie may, however, face considerable competition for their new drug, unless they choose to entre the drug into the market at a lower Wholesale Acquisition Cost (WAC) that Gilead Science’s latest pan-genotypic drug, Epclusa, which hit the market in late June at a price of $75,000 before discounts, rebates, or pricing negotiations. Viekira XR has not yet received a WAC announcement at the time of writing.
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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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