Rethinking Coverage and Access In Health Care – Hepatitis C

Rethinking Coverage and Access In Health Care – Hepatitis C

05.22.14 | By

Hepatitis C impacts an estimated 3.2 million Americans. Between 60 and 70% of those with hepatitis C develop chronic liver disease, between 5 and 20% will eventually develop cirrhosis, and an estimated 12,000 die from hepatitis C related illness each year.

New and forthcoming medicines are providing greater hope for cures with a new class of medicines increasing cure rates from 50% to upwards of 90%, while reducing treatment duration from 48 weeks or more to as low as 12 weeks, and importantly for patients, side effects have gone from debilitating to few. These medicines are the most effective tools at our disposal today to stop the progression of the disease and for many patients to cure them of this disease. 

None of this, however, is possible if these medicines don’t end up in the hands of the patients who need them. Some insurance companies and state Medicaid programs are concerned about the cost of these new medicines. However, given the societal benefit of completely curing patients, the cost-benefit analysis on these drugs appears straightforward – insurance and society should pay for these life-saving drugs.

As leaders in health care, it’s time that we start a conversation around how to provide patients with access to treatments that can halt the progression of disease and in some instances, provide an effective cure. This is preferable to delaying treatment until the disease has progressed when patients become much sicker and require more costly acute care, such as hospitalization or a major surgery. New treatments for hepatitis C effectively cure patients, whereas an untreated patient could develop end-stage liver disease and ultimately need a transplant that can cost over $500,000 on average and require many years of costly follow-up care. For hepatitis C patients that progress to end- stage liver disease, annual treatment is estimated to cost nearly $60,000 annually and for those with that progress to liver cancer, costs are estimated to be more than $112,000 annually.  As more people are cured of the disease, we also reduce the number of future infections. When they do get sick, we should focus on early treatment to hopefully avoid lengthy suffering and acute care. We must focus on the best possible approaches to bring down systemic costs. And we must do all of this together. 

New medicines today are providing patients with greater hope for cures.  Today, however, individual patients are paying an average of 20 percent out-of-pocket for prescription medicines, and only four percent for inpatient care. Singling out sick patients who need specialty medicines and restricting their coverage by requiring them to pay disproportionately high out-of-pocket costs for their medicine goes against the basic concept of health insurance coverage.  It’s critical that we refocus our efforts and incentivize disease prevention and early treatment, not wait for more costly, acute problems to arise. 

Similarly, singling out patients in the Health Insurance Exchanges by subjecting them to greater costs jeopardizes access to innovative medicines and likely increases overall health care costs. Patients deserve better. 

Access to innovative medicines helps improve and save lives. For patients suffering from hepatitis C, new approaches mean they no longer face high annual costs and suffer from debilitating side effects. The same increasingly applies to cancer, diabetes, HIV/AIDS and many other diseases. Millions of patients are free to live their lives to the fullest. However, we need a health care system that works for all of us who rely on it.

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