The cost of treating hepatitis C has dropped some in the past year or so. But price – drugs can list around 100,000 for a course – is still a barrier and can put a big burden on insurance programs like Medicaid, which has to make tough decisions about who qualifies for the lifesaving drugs.
Regional Appalachian pharmacy chain Fruth got a grant in 2016 from the National Association of Chain Drug Stores to begin offering hepatitis C testing for free. Hepatitis C is a virus spread by contact with infected blood that can cause cancer or severe liver damage if untreated. Blood transfusions that happened before 1992 and unsterile tattoos and piercings also put people at risk for hepatitis C. But by far the largest factor in the disease’s spread is intravenous drug use -- drugs like heroin.
“We see this as a problem in the community, this is our community that we serve,” said Jamie Bennett, clinical services leader at Fruth. Bennett is talking about the fact that West Virginia has some of the highest rates of hepatitis C in the nation.
There are 17 approved drugs for hepatitis C treatment, but a handful of the newer ones, such as Harvoni, Sovaldi and Zepatier, are much more effective than the others. They are also way more expensive.
“Currently for some of the medications, it’s almost close to 100,000 [dollars] for treatment for one person depending on the length of treatment,” she said. “So it’s really gone up of the last couple of years.”
Most people don’t pay that full price, though, especially in West Virginia where about a third of the population is on Medicaid. Jamie Bennett said the vast majority of hepatitis C prescriptions they fill are for Medicaid patients and the hepatitis C medication they fill the most of is Harvoni, made by Gilead.
Previously, Medicaid patients had to have a fibrosis, or liver damage, score of three out of four in order for West Virginia Medicaid to pay for treatment. In July, WV Medicaid moved that score to a two out of four.
“The companies are giving bigger rebates on their drugs,” explained Vicki Cunningham, director of pharmacy services for West Virginia Medicaid.
Cunningham wouldn’t say how much reimbursement WV Medicaid got from Gilead. And remember, West Virginia requires a liver damage score of two or higher for Medicaid to cover treatment. But we do have a ballpark.
In an emailed statement, Gilead said that on average, the price Medicaid pays per bottle is now less than $10,000 for states that provide open access to all patients, regardless of liver damage score. They did not respond to several inquiries for further clarification.
“The retail price looks the same if they were looking at it as a cash paying customer but for insurance companies the price has come down a bit,” said Cunningham.
According to Gilead, the actual price paid across all payers has come down by more than half since 2014.
When asked why WV Medicaid doesn’t treat everyone who tests positive for hepatitis C, Cunningham said, “We just can’t afford to treat everyone.”
And sometimes, she said, people heal spontaneously and don’t need to take the drugs at all. Research show this is true, but West Virginia University liver doctor Kevin Mullen said waiting can be risky.
“You can develop cancer of the liver, [if you wait] which is typically seen in patients that already have cirrhosis and have had it for quite a while,” he said. “So your risk of developing cancer is starting to rise as soon as you get to cirrhosis stage.”
But getting to that stage can take anywhere from one to 20 years, Mullen said.
“So the idea was to only treat people who were in imminent danger of dying from their hepatitis C so you get them on treatment when their disease is more advanced but the idea is they need it more at this point,” he said. “So we aren’t going to worry about the people who have very little fibrosis or scarring because they aren’t going to get in trouble for years. That’s not the way we usually do medicine by the way but this is the rationale behind making sure they have a lot of fibrosis before we treat them.”
And if the drugs were more affordable or accessible, Mullen said it’s possible, if everyone were to be treated and treated early, to eradicate hepatitis C.
Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation, Charleston Area Medical Center and WVU Medicine.