Report by Scott Kraus at The Morning Call (Contact Reporter)-
Three years ago, the outlook changed dramatically for patients with hepatitis C. Until 2014, a hepatitis C diagnosis meant a slow decline into cirrhosis, possibly liver cancer.
There was a treatment — a six to 18-month regimen of weekly interferon injections and daily doses of ribavirin pills that left many patients fatigued, achy, nauseous, even depressed. But for those with the most common form of the contagious disease, it offered only 40 percent odds of a cure.
Then in December 2013, the Food and Drug Administration approved Sovaldi, the first of several new drugs delivered in pill form that promised to cure more than 90 percent of cases in as little as two to three months, with minimal side effects.
The new treatment is the reason you see TV commercials urging baby boomers to get tested, an outgrowth of an initiative by the Centers For Disease Control and Prevention to identify those who are infected with hepatitis C, which has few symptoms until it has inflicted serious liver damage. While the treatment is available, it is also cost-prohibitive in the U.S. for many, making a cure elusive.
John Jezick, 60, of is a case in point. As a baby boomer, he already was five times more likely to have hepatitis C than the rest of the adult population, though the medical community isn’t sure why that generation is so susceptible. As a recovering heroin addict who spent time in prison, Jezick’s chances were even higher. And 30 years ago, he was diagnosed with the disease. He saw the toll the old treatments took on friends, and since he wasn’t experiencing much in the way of symptoms other than fatigue, he decided to let it go.
In October 2014, when the FDA approved Harvoni, the single-pill successor to Sovaldi, both produced by California-based Gilead, Jezick went to Lehigh Valley Health Network’s Allentown campus to see if he could finally get cured. Despite being on Medicare and Medicaid because of disabilities, it took more than a year for him to get approved for treatment.
“They didn’t want to give it to me right away because I didn’t have much liver damage at 58,” he said.
While hepatitis C can be a short-term illness, in more than three-quarters of those affected the infection is chronic and deteriorates the liver. The blood-borne virus is commonly transmitted through shared needles, though there are other, less frequent routes of infection, the CDC notes. People who received blood transfusions before 1992 are at risk because screening methods before then did not pick up the virus.
Jezick, who lives in North Catasauqua, finished his treatment in January and is now free of the disease. He feels better, and it’s a weight off his shoulders.
“I’m in here an hour and half every day,” he said, working out at a Planet Fitness gym in Allentown. “I think that says it all. My energy is great.”
Modern medicine has rarely seen such a transformation in the management of any illness as it has with hepatitis C, said Dr. Joseph L. Yozviak, an infectious disease specialist who practices internal medicine at LVHN.
Not surprisingly, patients like Jezick who had been diagnosed with hepatitis C but decided not to put themselves through the old treatment regimen, rushed to get the new medicines, he said.
“That is when the flood gates opened, and that is when the entire pharmacy budgets for many insurance plans were blown for an entire period,” he said.
The new treatments were costly, and many insurance plans balked at paying for them. They’re currently priced between $54,000 and $95,500 a course, which lasts about 12 weeks. Now many private insurers will cover the new drugs only if a patient is in later-stage liver damage, Yozviak said.
Jezick said his course of treatment, which took about three months, cost Medicare and Medicaid $115,000.
And even when people are covered, the co-payments can be significant.
That’s created a tension between the public push to identify the 3 million people health experts believe are infected with hepatitis C — many of whom don’t know it — and the need to cover the cost of curing them in time to prevent major liver damage.
“We have the tools to eliminate hepatitis C in the U.S., period,” Yozviak said. “However, we don’t have the access to such tools in order to eliminate hepatitis C in the U.S.”
What’s missing is a means to pay for the treatment, said Amy Nunn, executive director of the Rhode Island Public Health Institute and a professor at Brown University who has researched ways to get the new treatments to under-served populations. The TV commercials are a start, but more outreach is needed.
Right now, with the pool of patients relatively unknown, drug companies are pricing their products relatively high in the U.S. to recoup their research investments, she said. A key to bringing down the price will be identifying patients who are infected — generating a large pool of people who need treatment.
That would theoretically allow large insurers and the federal government to negotiate better bulk-purchase agreements that would lower the per-treatment cost.
To do that, it would take a federal government effort to identify and treat people with the disease and to help pay for it with subsidies or some other type of funding. That might cost money upfront, but be cost-effective in the long run.
There are some signs of improvement. The Department of Veterans Affairs recently lifted restrictions it was forced to place on hepatitis C treatment because of budget shortfalls. All veterans with the disease, an estimated 174,000, are now eligible for treatment regardless of the degree of liver damage, The Military Times reported last year.
The VA estimates it will pay $1 billion to treat the disease this fiscal year .
In the meantime, the CDC is urging people born between 1945 and 1965 to get tested before they develop chronic infections that make their conditions more urgent. Reach out to CAN for testing and treatment.