By: Marcus J. Hopkins, Blogger
In the state of West Virginia, any Medicaid beneficiary who is diagnosed with Hepatitis C must personally or through their prescribing doctor consult with either an Infectious Disease specialist or a doctor whose specialty includes Hepatitis C (e.g. – a Hepatologist) in order to have their prescription for Hepatitis C (HCV) Direct-Acting Antivirals (DAAs) approved. In addition, the patient must have a Metavir fibrosis score of F2 or higher as a prerequisite, as well as abstain from illicit drug and alcohol use for a period of 3 months.
These additional barriers to treatment are not only time consuming, but potentially costly. The consultation requirement, alone, exponentially increases the amount of money Medicaid must reimburse just in order to fill a prescription that can now be obtained for potentially $10k per patient (this, according to hearsay, since actual prices paid are forbidden from being made public by existing Trade Secrets laws). Beyond that, even current screening practices tend to require patients to see a specialist, just to get screened for the disease. This is both problematic, and relatively easily remedied.
With the introduction of HCV DAAs in 2013, HCV patients gained access to what was once thought improbable – a relatively easily tolerated “cure” with a high level of efficacy and considerably fewer and less serious side effects. Since that time, an additional nine HCV DAAs have been brought to the market, with newer drugs coming down the pike. The most recent release, AbbVie’s Mavyret, is a potential game changer, offering curative treatment in 8-to-12 weeks for roughly 1/3 to 1/2 the price of the most popular drugs on the market, while sharing essentially identical cure rates. In fact, Mavyret has become the Preferred Drug for several Medicaid Fee-for-Service and Managed Care Organization (MCO) plans since its approval in August of last year.
But, still, issues remain. In West Virginia, the rate of HCV more than doubled from 3.4 (per 100,000 persons) in 2015 (CDC, 2017) to a staggering 7.2 in 2016 (West Virginia Department of Health and Human Resources, 2018). While increased screening may account for this considerable increase, 68% of new Acute HCV infections listed Injection Drug Use (IDU) as the primary risk factor (WV DHHR, 2018), which indicates that increased screening of this community needs to be a priority.
Some of the ways that this can be accomplished is at the regulatory level – requiring screening of all adults in virtually every healthcare setting (e.g. – emergency rooms, primary care, community health centers, urgent care clinics, and correctional settings). In fact, in a simulation model, researchers from Boston Medical Center, Mass. General Hospital, and Stanford University found that this expanded screening protocol would increase life expectancy and quality of life, while also remaining cost effective (Legasse, 2018).
The strategy would also identify an estimated 250,000 more HCV cases than the current U.S. Centers for Disease Control & Prevention (CDC)-recommended strategy of focusing screening efforts on the Birth Cohort – individuals born between 1945-1965 (Green, 2018). This would have a projected benefit of increasing cure rates from 41% to 61%, while also reducing the risk of death from HCV-linked conditions by more than 20% compared to the current CDC guidelines (Toich, 2018).
It is clear that expanding screening to include all adults, rather than focusing efforts on the Birth Cohort and those whose doctors are aware of any other risk factors (because, let’s be honest – few people who inject drugs are open about that with most doctors, unless they’re there for an IDU-related condition or because of an overdose, at which point, it’s pretty obvious). Once we achieve THAT measure, we can move on to allowing Primary Care Physicians and Registered Nurses begin to administer and monitor HCV DAA therapy, because, it’s just not that difficult to do.
- Centers for Disease Control and Prevention (CDC). (2017, June 19). Surveillance for Viral Hepatitis – United States, 2015. Atlanta, GA: U.S. Department of Health and Human Resources: Centers for Disease Control and Prevention: National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention: Division of Viral Hepatitis. Retrieved from: https://www.cdc.gov/hepatitis/statistics/2015surveillance/index.htm
- Green, J. (2018, February 27). Testing all adults for HCV cost-effective, improves outcomes. Thorofare, NJ: Healio [dot] com: Infectious Diseases: Hepatitis C. Retrieved from: https://www.healio.com/infectious-disease/hepatitis-c/news/in-the-journals/%7B34c08c02-2305-4866-a12c-5e25fadcb1a0%7D/testing-all-adults-for-hcv-cost-effective-improves-outcomes
- Legasse, J. (2018, February 22). The case for testing all adults for Hepatitis C: It’s safer and more cost-effective than what many hospitals do. Chicago, IL: Healthcare Finance. Retrieved from: http://www.healthcarefinancenews.com/news/case-testing-all-adults-hepatitis-c-its-safer-and-more-cost-effective-what-many-hospitals-do
- Toich, L. (2018, February 27). Study: Testing All Adults for Hepatitis C Virus is Cost-Effective. Cranbury, NJ: Pharmacy & Healthcare Communications, LLC: Specialty Pharmacy Times. Retrieved from: https://www.specialtypharmacytimes.com/news/study-testing-all-adults-for-hepatitis-c-virus-is-cost-effective
- West Virginia Department of Health and Human Resources. (2018, January). HEPATITIS B AND HEPATITIS C INFECTION IN WEST VIRGINA – An Evaluation of 2016 Surveillance Data. Charleston, WV: West Virginia Department of Health and Human Resources: Bureau for Public Health: Office of Epidemiology and Prevention Services: Division of Infectious Disease Epidemiology. Retrieved from: https://dhhr.wv.gov/oeps/disease/viral-hepatitis/Documents/HBV-HCV_Surveillance_Eval.pdf
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.