Valerie Green is still waiting to be cured.
The Delaware resident was diagnosed with hepatitis C more than two years ago, but she doesn鈥檛 qualify yet for the聽Medicaid program鈥檚 criteria for treatment with a new class of highly effective but pricey drugs.聽The recent approval of a聽less expensive drug that generally cures hepatitis C in just eight weeks聽may make it easier for more insurers and correctional facilities聽to expand treatment.
The drug, ,聽is the first to be that can cure all six genetic types of hepatitis C聽in about two months in patients who haven鈥檛 previously been treated.聽Other approved drugs generally require 12 weeks to treat the disease and often aren鈥檛 effective for all types of hepatitis C.
In addition, Mavyret鈥檚 price tag of $26,400聽for a course of treatment is significantly below that of other hepatitis C drugs whose sticker price ranges from about to beat the disease. Patients and insurers often pay less, however, through negotiated insurance discounts and rebates.
鈥淚t certainly stands to reason that the continual march downwards on cost would lead to continual opening up of criteria,鈥� said Matt Salo, executive director of the National Association of Medicaid Directors.
Hepatitis C is a viral liver infection spread through blood that affects an estimated 3.5 million people in the United States. It can take years to cause problems. Many baby boomers who contracted it decades ago before blood was screened for the virus don鈥檛 realize they have it until they develop liver disease. In addition, the growing heroin epidemic is adding to the problem as people聽become聽infected by sharing contaminated聽needles.
鈥淒irect acting antiviral鈥� therapies like Harvoni, a once-a-day pill introduced in 2014 that generally cured hepatitis C in 12 weeks, are much more effective than earlier treatments that required weekly interferon injections and multiple daily pills for nearly a year. But the newer regimens came at a price: $94,500, in Harvoni鈥檚 case.
State Medicaid programs, which cover a high proportion of people with hepatitis C, , even with the 23 percent drug discount the programs typically receive.聽 Many threw up roadblocks to limit drug approval until the聽disease was聽advanced. Some required people to be drug- and alcohol-free for six months or more before treatment would be approved.
Those moves prompted advocates to push for better access, in some cases filing suit to force the programs to cover more people.
Faced with a lawsuit in Delaware, the state Medicaid program began loosening up treatment criteria this year, and in January will regardless of the severity of their disease.
The state joins more than a dozen others that no longer (or never did) restrict hepatitis C treatment based on disease severity, said Kevin Costello, director of litigation at Harvard Law School鈥檚 Center for Health Law and Policy Innovation, which has been a key player and other states.
It can鈥檛 happen soon enough, said Green, 58, who believes she contracted the disease 31 years ago when she suffered complications during childbirth and required a blood transfusion. Although her liver isn鈥檛 damaged, Green said, she鈥檚 suffered with abdominal and joint pain, weight loss and fatigue for decades, symptoms that doctors attribute to the hepatitis C virus.
鈥淚t鈥檚 been a difficult fight for us Medicaid patients,鈥� she said.
People who are incarcerated to get treatment for hepatitis C. Roughly 17 percent of prisoners are infected with hepatitis C, compared with about 1 percent of the general population.
Prisons have a duty not to be deliberately indifferent to the medical needs of incarcerated people. Prisons don鈥檛 get the price discounts that the Medicaid programs have, and their budgets are fixed.
鈥淎dministrators have to make do with what is there,鈥� said Dr. Anne Spaulding, an associate professor at Emory University鈥檚 public health school who has worked as a medical director in corrections and published research on hepatitis C among prisoners.
Lawyers in a handful of states are pursuing class action lawsuits to force prisons to provide hepatitis C treatment. Mavyret may make a difference, said David Rudovsky, a civil rights lawyer who鈥檚 litigating a class action lawsuit against the Pennsylvania Department of Corrections.
鈥淓veryone recognizes that it鈥檚 going to make it easier to cover people,鈥� he said.
People with regular private insurance may face some obstacles to coverage of hepatitis C, but coverage is typically less problematic. For example, Mavyret is one of seven hepatitis C drugs that are included in the 2018 聽by Express Scripts, which manages the pharmacy benefits for 83 million people.
鈥淭he benefit to patients and payers is the additional competition, which brings down costs across the class, thus resulting in greater access and affordability,鈥� said Jennifer Luddy, director of corporate communications at Express Scripts.
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