Fantastic Hep C News

[lporterrn]

Great news about access to hep C treatment for Medicaid patients: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Prescription-Drugs/HCV-Communication.html

I feel confident that insurance companies will be forced to follow suit (eventually)

[tbroder]

And the Associated Press has already picked up the story:

www.nytimes.com/aponline/2015/11/05/us/politics/ap-us-hepatitis-drugs.html

Feds Worry That Low-Income People May Not Get Hepatitis Cure
By THE ASSOCIATED PRESS
NOV. 5, 2015, 6:12 P.M. E.S.T.

WASHINGTON — Confronting the consequences of high-priced drugs, the Obama administration Thursday pointedly reminded states that they cannot legally restrict access by low-income people to revolutionary cures for liver-wasting hepatitis C infection.

The federal Centers for Medicare and Medicaid Services also sent letters to several drug manufacturers, requesting details of what they are doing to make their medications more affordable.

The moves echoed government pressure decades ago to make sure that low-income people covered by federal-state Medicaid programs had access to ground-breaking HIV treatments. It's coming at a time the cost of prescription drugs is the leading health care issue for the public, according to opinion polls.

Hepatitis C is a viral illness that affects some 3 million people in the U.S. and claims more lives here than AIDS. Patients say it feels like a bad flu that never goes away. While the disease advances gradually, it can ultimately destroy the liver, requiring a transplant to save the patient's life.

Previous treatments were hit and miss, and many patients couldn't tolerate the side effects. With new drugs like Harvoni and Viekira Pak, patients finally have a choice among highly effective cures with minimal side effects. But with a course of treatment priced at around $100,000, the costs are straining government programs and private insurers alike.

In a notice to state Medicaid directors, the administration reminded states of their legal obligations to cover prescription medications for the poor.

Federal officials said they are concerned that some states are restricting access "contrary to ... statutory requirements" by "unreasonably" imposing limitations on which patients can get the new drugs.

They questioned requirements by some states that patients must have advanced liver disease first before they can get the cure. Since the new drugs cure hepatitis C, doctors say such restrictions don't make sense from a clinical perspective. Federal officials also cited requirements by some states that patients abstain from illegal drugs and alcohol as condition of getting treatment.

The administration also requested explanations from drug companies that make, or are working on, breakthrough treatments. Although Medicaid programs are entitled to substantial savings from drug makers, that hasn't been sufficient with the new hepatitis C drugs. Officials also asked for details on what the companies are doing to help states cover the cost of their medications.

[Lynn K]

I have a friend who works for the same company as I do and cannot get Harvoni for her husband. He is F1 fibrosis and recently retired. We are supposed to have great insurance at our company BCBS with Express Scripts Accredo PBM. Large company with 130,000 employees nationwide.

Will this have a trickle down effect for people who have insurance through their employers?

[lporterrn]

I believe it will. Today we talked to the folks at the Hep C Careline - they are educating the insurance companies about the recent changes to the HCV guidelines which clearly state that everyone should be treated (unless you are expected to die soon): http://www.hcvguidelines.org/ I highly suggest that people work with an advocate, such as the Patient Advocate Foundation's Hepatitis C CareLine or otherrs listed here:  http://www.hepmag.com/articles/2512_20506.shtml

[MaryC]

This is great news and hopefully the start of a new trend to treat EVERYONE with Chronic HCV! 

Mary

[Joe NM]

Lynn K - it may be that his insurance will only pay for Viekira Pak (with or without ribavirin, depending on his exact genotype), because that's the preferred drug on Express Scripts. Lucinda has a great article on this exact situation (http://www.hepmag.com/articles/hepatitis_dark_side_2502_27953.shtml) V-Pak is just as effective (generally--dangerous for F4, and ribavirin has its dangers as well of course) as Harvoni at curing HCV, but has some down-sides...but he'd have to decide for himself what to do. This forum has a lot of people on treatment with V-Pak who I'm sure could offer insight into the experience.

[Joe NM]

One of the Managed Care Medicaid programs in my state just slipped my clinic some information on the sly today...they're dropping all the fibrosis score and sobriety requirements from their approval criteria for Viekira Pak (and apparently it is NOT a coincidence that the CMS letter went out yesterday). Still not perfect at all, but a huge improvement over what they had previously been doing (basically, approving nobody for any HCV med). Hopefully more changes are on the way! And hopefully Gilead starts offering serious discounts the way Abbvie has so more people can get Harvoni, Sovaldi, and their upcoming pan-genotype drug!

[Lynn K]

Lynn K - it may be that his insurance will only pay for Viekira Pak (with or without ribavirin, depending on his exact genotype), because that's the preferred drug on Express Scripts. Lucinda has a great article on this exact situation (http://www.hepmag.com/articles/hepatitis_dark_side_2502_27953.shtml) V-Pak is just as effective (generally--dangerous for F4, and ribavirin has its dangers as well of course) as Harvoni at curing HCV, but has some down-sides...but he'd have to decide for himself what to do. This forum has a lot of people on treatment with V-Pak who I'm sure could offer insight into the experience.

Yes Joe that is exactly what he is facing but he also has some sort of heart condition so not sure that is the way to go. Personally not a big fan of Viekira Pak because of the more complicated regimen and the need to take with ribavirin not sure if ribavirin and heart trouble is a good idea. And of course my friend and her husband are not up to speed like we are on the ins and outs of this whole thing.

They were surprised they didn't just walk out from their doctor appointment with a prescription and get it filled that day by their local pharmacy.

Oh were it that easy.....