Tag Archives: Medicaid

Navigating Patient Assistance Programs

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

Since HEAL Blog began publishing, we have striven to provide information about Hepatitis C (HCV) treatments, news, and issues surrounding the disease. We have also, on occasion, provided information related to Patient Assistance Programs (PAPs) that can help patients living with Hepatitis (HCV), HIV, or virtually any other illness afford the cost of their medications and treatments if they are unable to do so. Continuing along this line of thinking, today’s blog will be dedicated to three such organizations: NeedyMeds, the Patient Access Network (PAN) Foundation, and the Patient Advocate Foundation (PAF and NPAF).

Money flowing out of an open pill capsule

Photo Source: Chemistry World

NeedyMeds is a 501(c)(3) national non-profit information resource dedicated to helping people locate assistance programs to help them afford their medications and other healthcare costs (NeedyMeds, 2017a). They provide a NeedyMeds Drug Discount Card designed to lower the cost of prescription medications by up to 80% (NeedyMeds, 2017b). The discount card can be used cannot be combined with insurance or Medicaid/Medicaid drug coverage plans, but can be used in lieu of those plans to reduce the out-of-pocket costs of the medication. In some cases, using the NeedyMeds card instead of insurance may result in a lower cost to the patient than their insurance co-pay.

In addition, NeedyMeds’ website offers a variety of resources to help connect patients to other programs and organizations. These links include information pertaining to various drug-specific PAPs, a “Help with Paperwork” assistance service, a searchable database of both independent and manufacturer PAPs, and local resources to help patients apply for these programs (NeedyMeds, 2017c).

The PAN Foundation is an independent, national 501(c)(3) organization dedicated to helping federally and commercially insured people living with life-threatening, chronic and rare diseases with the out-of-pocket costs for their prescribed medications. Partnering with generous donors, healthcare providers and pharmacies, PAN provides the underinsured population access to the healthcare treatments they need to best manage their conditions and focus on improving their quality of life. Since its founding in 2004, PAN has provided more than 700,000 underinsured patients with over $2.5 billion dollars in financial assistance, through over 50 disease-specific programs. PAN has an administrative fee of only 5%. This means that $0.95 of every dollar PAN receives goes directly toward helping patients. For the last eight years, PAN spent less than one penny of each dollar it received on fundraising (PAN Foundation, 2016a).

The PAN Foundation has nearly sixty disease-specific assistance programs that help patients pay for out-of-pocket healthcare costs, including deductibles, co-pays, and co-insurance, travel expenses, and health insurance premiums, all of which are listed in a convenient, searchable database listed by condition (PAN Foundation, 2016b). This list also indicates the enrollment status of each program as Open (accepting applications for new and renewal patients), Renewal Only (accepting applications for renewal patients, only), and Fully Allocated (no longer accepting or processing applications for new or renewal patients). As of May 31, 2017, the programs for both HIV and HCV are open to new enrollees and renewals.

The Patient Advocate Foundation (PAF) is a national 501(c)(3) non-profit organization which provides professional case management services to Americans with chronic, life threatening and debilitating illnesses. PAF case managers serve as active liaisons between the patient and their insurer, employer and/or creditors to resolve insurance, job retention and/or debt crisis matters as they relate to their diagnosis also assisted by doctors and healthcare attorneys (PAF, 2012a). These services are vital to patients who may not be familiar with the complex workings of the American healthcare system (and let’s face it – most of us aren’t).

One of the primary goals of PAF (and their advocacy arm, National PAF – NPAF) is to reduce the financial burden by assisting patients in finding potential assistance that provide financial support for co-pays, discount and indigent drug programs, transportation, housing, food, utility shut offs, and by helping negotiate payment plans for treatment providers. They also assist patients by assessing eligibility and helping with enrolling patients in the various programs, as well as providing a baseline of employment-related support as needed.

As with all PAPs and independent and government programs, there are financial and other prerequisites that clients must meet in order to qualify. One of the biggest barriers to enrollment in co-pay assistance programs (both organizational- and manufacturer-funded) is enrollment in a government-funded healthcare program, such as Medicaid. Being enrolled in Medicaid generally disqualifies applicants from receiving assistance, even if the out-of-pocket expenses with Medicaid coverage are more than what patients can afford. There seems to be little “wiggle room” in PAPs that allow these patients to receive assistance, and this is a significant barrier that has yet to be addressed in any meaningful way.

Patient Assistance Programs are vital tools that can help patients afford the medications and treatments they need in order to survive. Moreover, they are resources that most patients, and even healthcare workers, rarely know about or reference, which makes them a potentially untapped source of aid in today’s volatile healthcare market. HEAL Blog will continue to monitor PAPs and to provide more information over time.

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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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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Treating HCV in Pediatric 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

In April of this year, the Food and Drug Administration (FDA) approved the use of Sovaldi and Harvoni (Gilead) for use in treating Hepatitis C (HCV) in pediatric patients aged 12-17. This is an important step in treating HCV in no small part because children and teenagers are considered a vulnerable population. They are, for the most part, not properly equipped to make well-informed decisions about their health, leaving treatment decisions in the hands of the adults who care for them.

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

Photo Source: 3Dprint.com

Treating pediatric patients is a much riskier prospect, because people outside of the medical community consider children to just be “small adults;” virtually every treatment regimen for every disease must be modified to achieve commensurate outcomes. There are a variety of reasons why this is so, from bodyweight variances between children and adults, to the various ways that physical and chemical changes that occur during the growth and development process from childhood to adulthood can impact how medications behave in pediatric patients. Essentially, “results may vary.”

The new FDA ruling that expands treatment to pediatric patients allows patients weighing at least 77 lbs. to take an unmodified regimen. While access to treatment in adults has proven fraught with hurdles to overcome before being approved by payers, children covered by Medicaid may, in fact, face fewer hurdles than adults. This is due to the following provision: under Federal law, state Medicaid programs must cover “…early and pediatric screening, diagnostic, and treatment services” for children under age 21 that are necessary to correct or ameliorate physical and mental illnesses (Andrews, 2017). While that’s great for patients covered by Medicaid, those covered by private insurers may have a tougher road to hoe, as most within the industry expect the latter payers to largely maintain similar restrictions in pediatric clients as adults.

One of the reason pediatric patients are so vulnerable is that the majority of HCV-infected patients acquire the disease in the womb; only about 20% acquire it through drug use (Andrews). That said, the likelihood is very low – only a 6% chance that babies will acquire HCV if the mother has it.

Hopefully, pediatric patients will face an easier time gaining access to Sovaldi and Harvoni than adults, but only time will tell.

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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Data Analyses Indicate HCV Treatment for All Saves Money; Part 2

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

Last week, HEAL Blog discussed some of the thinking behind a “Treatment for All” paradigm for dealing with America’s burgeoning Hepatitis C (HCV) problem. The argument put forth in the study released in the American Journal of Managed Care (AJMC; Younossi et al, 2017) suggests that adopting a policy of treating every HCV-infected client on government-funded healthcare rosters will ultimately lead to long-term cost savings by reducing the incidence of multiple co-morbidities, such as cirrhosis, hepatocellular carcinoma, and the number of liver transplants. This is a position that advocates (including HEAL Blog) have been arguing for years – since the release of Sovaldi (Gilead) and Olysio (Janssen) in 2013. The pharmaceutical companies who manufacture Direct Acting Agents (DAAs) to treat HCV have been arguing this position, as well.

Read Part 1, “Data Analyses Indicate HCV Treatment for All Saves Money

All of these parties are coming up against the stark reality of the budgetary process. Rather than being calculated based on long-term expenditures, they are calculated using estimated yearly expenditures using the amount of money given to them by the Federal and state governments – resources that are limited, and unlikely to increase without significant increases in tax revenues generated by tax hikes (business, corporate, and personal) or some unexpected increase in profits that comes out of nowhere. Medicaid directors and drug purchasing officials have repeatedly made the claim that treating everyone on their rosters infected with HCV will outstrip their pharmacy budgets several times over. Tom Burns, head of drug purchase for the Oregon Health Authority in 2014, said in an interview that “…Oregon can afford to wait” to see how other HCV drugs develop, and that “…the vast majority [of the 5,600 clients infected with HCV] could wait while we figure out a policy that doesn’t bankrupt this state” (Millman, 2014).

Image of a stethoscope wrapped around a $20 bill , laying next to an open medication bottle

Affordable Healthcare

This line of thinking has been echoed by virtually every state’s Medicaid program. The Centers for Medicare and Medicaid Services (CMS), however, didn’t buy that line, and in 2015 issued an official guidance that reminded Medicaid programs that they are required by law to cover these drugs under section 1927(b) of the Social Security Act (CMS, 2015). Furthermore, states facing litigation related to treating HCV patients have found little sympathy from the Judicial Branch. In May 2016, Federal U.S. District Court Judge John C. Coughenour ordered Washington state’s Medicaid provider to cover HCV drugs for all patients by granting a preliminary injunction that forced the state Health Care Authority (HCA) to halt a 2015 policy that restricted access to the drugs based on a fibrosis score (Aleccia, 2016). This injunction was in response to a class action lawsuit against Apple Health, Washington’s Medicaid program, on behalf of two clients and 28,000 other enrollees. Another Federal U.S. District Judge, Robert Mariani, ordered the Pennsylvania Department of Corrections (DOC) to provide HCV treatment to well-known inmate, Mumia Abu-Jamal (Moran, 2017). While his ruling applied only to Abu-Jamal, the judge went on record, stating that the DOC’s interim protocol for treating HCV “…presents deliberate indifference to the known risks which follow from untreated chronic Hepatitis C.”

The report in the AJCM found that if Medicaid in the U.S. continues its use of restrictions to treatment, the estimated total cost of treating the HCV cohort will come to $9.7 billion, with the majority of costs (50.4%) attributable to downstream costs of care (i.e. – hospitalization costs, outpatient costs, and non-Harvoni pharmacy costs). Conversely, treating all Medicaid patients with Chronic HCV using Harvoni led to a 39.4% savings – $3.8 billion – over the model time horizon and decreased the relative proportion of total costs attributable to downstream costs of care to 18.3% (Younossi).

While most of the cost savings were related to downstream medical cost offsets, even the pharmacy costs attributed to Harvoni treatment over non-Harvoni treatment decreased 2%, from $4.84 billion to $4.75 billion. This is due in part to the 9,618 patients in the cohort potentially eligible for an 8-week regimen of Harvoni to achieve a Sustained Virologic Response (SVR), rather than the traditional 12-week regimen. Treating all Medicaid patients with Harvoni led to a 19.8% savings per SVR, given that earlier treatment of HCV resulted in better health and cost outcomes (Younossi).

Though this analysis is a fantastic tool, another harsh reality is the [potential] repeal and replacement of the Affordable Care Act (ACA). It was announced, last week, that the Fiscal Year 2018 budget resolution has been put on hold, pending the repeal of the ACA (Shutt, 2017). This means that any type of Federal budgeting process for Medicaid (as well as the Centers for Disease Control, and other domestic spending programs) has stalled for the foreseeable future, leaving virtually everyone involved in those organizations in the lurch, waiting for their fates to be handed down to them. Most HIV and HCV advocates, however, are heartened by Tom Cole (R-OK) saying, “We thought it was wrong when Democrats said for every increased dollar on defense, you had to increase domestic. It’s just as wrong to say for every increase on defense you have to cut domestic.” He finished that statement, however, by saying that he believes those increases should be offset on “…the entitlement side of the ledger.” That statement is considerably LESS heartening.

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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Data Analyses Indicate HCV Treatment for All Saves Money; Part 1

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

Since the introduction of Sovaldi (Gilead) and Olysio (Janssen) in 2013, Hepatitis C (HCV) advocates have argued several points: (1.) that the price for these drugs was/is too high; (2.) that Medicaid is required to pay for these treatments by law; (3.) that ensuring that HCV-infected patients achieve a Sustained Virologic Response (SVR – “cure”) will reduce the cost of care over time. This last point was the subject of a recent report published in the American Journal of Managed Care (AJMC).

The argument goes like this: HCV is a deadly virus that results in liver cirrhosis, eventual liver failure, and ultimately death; it is also can result in a number of co-morbidities that are costly to treat, including cancer, liver disease, connective tissue disease, abdominal pain, and upper and lower respiratory infections. That said, state Medicaid programs consistently place incredibly stringent Prior Authorization (PA) prerequisites on patients in order for their treatment to be covered, that can include mandatory enrollment in a drug or alcohol recovery program or treatment facility, a mandatory period of abstinence from all drugs or alcohol, failure of other, less easily tolerated treatment regimens, and meeting a certain stage of liver fibrosis (F-Score). These prerequisites are put in place in order to defray the high cost of treatment, ultimately resulting fewer patients being approved and less money being spent.

Advocates and economists, alike, have been arguing for years that the long-term costs associated with leaving HCV patients either untreated, or treated with older Pegylated Interferon-based regimens rather than with newer Direct Acting Agents (DAA) that are more easily tolerated and have a higher SVR rate will ultimately cost Medicaid and other government agencies (as well as private payers) more over time. Medicaid officials from several states have argued that treating every patient on their rosters would not just outstrip their existing pharmacy budgets, but do so four-times over, thus bankrupting the program. Drug manufacturers – Gilead Sciences, in particular – have argued that the cost of one-time treatment for a cure is less expensive than the cost of treating other serious conditions, whose cure rate is far lower, and takes far longer, ranging a period of years, to end in a positive result. The reality is that none of these parties are wrong.

The report in the AJMC, “Treating Medicaid Patients With Hepatitis C: Clinical and Economic Impact,” does an excellent job of outlining all the various consequence related to allowing HCV to go untreated until liver decomposition reaches a certain stage and concludes that adopting a “treat all” strategy will ultimately result in a 39.4% ($3.8 billion) savings and decrease the proportion of total costs attributable to downstream costs of care to 18.3% (Younossi, 2017). It also looks at how Medicaid programs arrived at the current “wait for treatment” model that prevents many patients from being approved for newer DAA regimens.

In next week’s post, HEAL Blog will get into the details of their analysis, their methodology, and their recommendation, as well as look into the feasibility of their proposal – that all state Medicaid programs adopt a “treat all” approach to approving HCV regimens.

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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The 2016 Election, and What This May Mean for Healthcare

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 passage of the Affordable Care Act (ACA), also known as Obamacare, included a provision that gave states the option to expand Medicaid coverage in order to cover citizens whose incomes were above the Federal Poverty Level (FPL), but whose incomes still present a significant barrier to purchasing health insurance. Of the 50 United States and the District of Columbia, 32 states (including DC) have opted to expand their Medicaid programs. Nineteen states have opted not to expand access.

Expanding access to Medicaid is an essential piece of the ACA, as it was designed to help increase the number of people with access to affordable healthcare. Because the ACA envisioned low-income people receiving coverage through Medicaid, it does not provide financial assistance to people below poverty for other coverage options. As a result, in states that do not expand Medicaid, many adults fall into a ”coverage gap” of having incomes above Medicaid eligibility limits, but below the lower limit for Marketplace premium tax credits (Garfield & Damico, 2016). Since the expansion of Medicaid under the ACA, 73,137,154 Americans were enrolled in Medicaid/CHIP as of August 2016 (Henry J. Kaiser Family Foundation, 2016).

There are an estimated 2.6 million Americans who currently fall into that coverage gap, and of the states that did not expand Medicaid, four states represent 64% of those people (TX – 26%, FL – 18%, GA – 12%, NC – 8%). When looking at the geographic distribution of those 2.6 million Americans, 91% are in the American South (Garfield & Damico, 2016). Demographically, 46% are White non-Hispanics, 18% are Hispanic, and 31% are Black, and over half are middle-aged (age 35-54) or near elderly (55 to 64). Additionally, the majority of people in the coverage gap are in poor working families.

Donald J. Trump

Photo Source: NBC News

President-elect, Donald J. Trump, as well as the incoming Republican-led Congress and Senate, have openly stated that their first priority, at the beginning of the next legislative session, is the repeal of the ACA. There are very few comprehensive plans being proffered to replace the ACA, and healthcare professionals, providers, payers, patients, and advocates, alike, are currently unsure about the future of the expansion, and whether or not that aspect of the ACA will be retained in the forthcoming repeal.

It bodes poorly for those existing people infected with viral hepatitis, especially Hepatitis C (HCV), who stand to lose coverage if the Medicaid expansion does not survive the repeal, even with the existence of drug manufacturer and private Patient Assistance Programs (PAPs). In order for those PAPs to be accessed, however, people must first know about them; without the aid of social workers, healthcare aides, and advocates, people living with HCV are unlikely to find out about these PAPs, unless this information is provided to them by a doctor or nurse.

An additional concern exists for those recipients of the Ryan White Program. Over the past eight years, HIV/AIDS advocates and policy wonks have been in a near-constant debate about whether to reopen the Ryan White Care Act for reauthorization to address some of the ways in which the current law has not necessarily aged well, in terms of keeping up with newer treatments, costs, and funding paradigms. The concern over the past five years has been that the Republican-controlled Congress would “gut” the bill, cutting out many of the provisions upon which organizations and patients have come to rely. With repealing the ACA having played such a large role in this year’s election, concerns about reopening the act are likely to deepen, rather than abate. It is important to note that many states include HCV therapies under their AIDS Drug Assistance Program’s drug formularies.

The HEAL Blog  will pay close attention to both programs, as well as other HIV and HCV-related issues throughout 2017.

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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Veteran’s Administration $1.5 Billion for HCV to Expand Coverage

By: Marcus J. Hopkins, Blogger

Veterans Administration logo

Photo Source: VA

The Veteran’s Administration (VA) has requested $1.5 billion in the Fiscal Year 2017 (FY2017) budget in order to treat more veterans for Hepatitis C (HCV). This move comes after the announcement in March that the VA would be expanding treatment protocols to include all veterans in its health system with the virus, regardless of age or progression into liver cirrhosis (Kime, 2016). This coverage expansion was covered in the HIV/HCV Co-Infection Watch Report in April, and was recently reported in the Journal of the American Medical Association (JAMA) in the September edition.

With more than $2 billion appropriated for new HCV drugs during the past two years, the VA has treated 65,000 veterans for the virus (Wentling, 2016). One of the primary concerns expressed by veterans’ groups – Disabled Veterans (dot) Org, in particular – has been the rationing of care to only those whose liver fibrosis scores met what they feel are arbitrary measures that focus more on saving money, rather than saving lives. Tom Berge, head of the Vietnam Veterans of America (VVA) health care panel, went so far as to say the following: “When I found out that they were prioritizing the treatments, that’s when I said they were death panels (Krause, 2016).” The “death panels” claim is reminiscent of political arguments against single-payer or Universal healthcare coverage, wherein bureaucrats essentially decide which people would live or die, based on a set of predetermined markers.

The rationing of treatment to the sickest or most financially able to pay is nothing new – public and private insurers and payers, alike, have utilized these formulae and markers in an effort to reduce costs while still maintaining the visage that they “cover” drugs, even if actual utilization on the part of patients is low. With HCV drugs, in particular, many Medicaid and ADAP programs have indicated in their respective Preferred Drug Lists (PDLs) and formularies that they cover the new Direct Acting Agents (DAAs) that are currently considered to be the Standard of Care (SOC) for HCV, only to have the Centers for Medicare and Medicaid Services (CMS) release a guidance in November 2015 reminding Medicaid programs that “cost” was not an acceptable reason to deny coverage. Certain states – Arizona, for example – openly stated that they would not be following said guidance.

The VA currently estimates that 107,000 vets have undiagnosed or untreated HCV (Wentling, 2016), with Vietnam War-era veterans born between 1945 and 1965 being one of the demographics most likely to have been infected, as this generation (generally referred to as “Baby Boomers”) may have been the recipients of blood transfusions and organ transplants prior to the discovery and screening of blood for HCV. It wasn’t until 1992 that widespread screening of the blood supply began in the United States.

While this demographic is a target for HCV screening, most new HCV infections occur as a result of sharing syringes or other equipment to inject drugs (Centers for Disease Control and Prevention, 2016). Veterans are particularly susceptible to prescription opioid and heroin addiction. According to VA officials, roughly 60% of those returning from deployments from current engagements in the Middle East and 50% of older veterans suffer from chronic pain. That’s compared to about 30% of Americans, nationwide. Additionally, veterans are twice as likely to die of accidental opioid overdoses than non-veterans. Prescriptions for opioid drugs rose by 270% over a twelve-year period by 2013 (Childress, 2016). This places veterans at particular risk of contracting HCV as a result of Injection Drug Use (IDU).

Though the cost of treating HCV are currently astronomical, on a national scale, the VA does benefit from a requirement that drug manufacturers provide the system with the “best price,” though those discounts are currently shielded by Trade Secrets laws that specifically forbid programs from publicizing any deals, discounted prices, or pricing arrangements struck between pharmaceutical companies and payer programs. But, we have asked of our veterans that they make sacrifices to ensure our continued freedom and safety; is any price too high to ensure their continued health and wellbeing if and when they return from battle? I think not.
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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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