Patient Population Eligible for Hepatitis C Treatment Limited by High Costs

Patient Population Eligible for Hepatitis C Treatment Limited by High Costs

Hepatitis CDespite the hope generated by more efficacious, safer hepatitis C drugs within the past years, a number of patients with the chronic liver disease may not qualify for access to treatment, according to a new report. Unless patients have serious liver damage, they will not be able to receive the drugs due to exorbitant costs.

“Everybody is trying to figure out how best to deliver needed treatments without blowing out resources because of the cost,” said Brendan Buck, spokesman for America’s Health Insurance Plans, in a news report from NPR. Currently, treatment for one patient is approximately $95,000 for 12 weeks, a cost burden too great for private or public insurers to cover for all 3.2 million hepatitis C patients.

One tactic employed by insurers is to restrict prescription of drugs by only certain clinicians and to only certain patients who have shown early signs of improvement. Additionally, patients who use non-prescription drugs and alcohol are likely to be denied treatment.

Available treatments include Gilead Sciences’ drugs Sovaldi and Harvoni. Gilead stated, “The price of Gilead’s hepatitis C treatments reflects the significant clinical, economic, and public health value of these drugs, and is comparable to, or in many cases less than, the cost of older, less effective regimens.”

However, patients lucky enough to be prescribed Sovaldi, such as 53-year-old Paul Walker from Tyler, Texas, are sometimes denied by their insurance companies, according to the NPR report. Blue Cross Blue Shield (BCBS) of Texas denied Walker’s physician’s request for Sovaldi. Denial was on the premise of an off-label combination of Sovaldi with Olysio, another hepatitis drug, instead of the approved combination of Sovaldi and interferon.

“We are committed to providing members access to quality, cost-effective medications,” stated Dan McCoy, chief medical officer of BCBS of Texas. “Our coverage criteria is based on clinical trial data, published literature, and recommendations from a wide variety of medical specialty societies.”

This hard fact led Walker’s physician to prescribe the recently approved Harvoni, which could slash costs by a third due to a potential treatment time of only eight weeks, rather than twelve. “Until I actually get the medication and am cured there’s going to be a lot of anxiety,” said Walker.

Specific coverage criteria varies with patient and insurance company, making it possible for some patients to be treated, but not others. Until costs of hepatitis C treatments are more manageable for insurers, there will continue to be an unmet need for hepatitis C patients.

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Maureen Newman is a researcher by trade, and brings her knowledge of the lab to BioNews Texas. Currently, she is serving as a PhD student at University of Rochester, and working towards a career of research in biomaterials for drug delivery and regenerative medicine. She is an integral part of Dr. Danielle Benoit’s laboratory, where she is investigating bone-homing therapeutics for osteoporosis treatment. She is a senior science and research columnist for BioNews Texas.

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