Health Experts to White House: "Widen Access to Hepatitis C Medications"

Experts from the Public Health Service and President Obama’s Advisory Council on HIV/AIDS have asked the administration in a letter to widen access to new, high-cost medications that successfully treat hepatitis C.

Gilead’s Sovaldi^® and Harvoni^®, which can cost up to $84,000 for the recommended course of treatment, have revolutionized treatment for the condition, which is a bigger killer than AIDS in the United States. Despite the new treatments that effectively cure hepatitis C available from Gilead — and newer ones on the way from Merck, Abbvie, Bristol-Meyers Squibb, and others – as many as 1.4 million people die each year from viral hepatitis. Millions more are infected but don’t yet know it.

Medicaid is jointly funded by the state and federal governments but is managed by the states. Each state has broad leeway to determine who is eligible for its implementation of the program and who is eligible for specific types of coverage within the program. Many of those state guidelines haven’t yet caught up to the general consensus among practitioners and public health officials that the health benefits of these new medications outweigh their costs. In addition to recommending that Medicaid expand coverage for Sovaldi and Harvoni, the groups suggested that Gilead and other pharmaceutical manufacturers should be required to disclose the costs of developing and producing the medications.

The Advisory Council criticized state and federal restrictions that cover the new drugs only under certain conditions. In some states, for example, the drugs are only covered for patients who have advanced liver disease. Other restrictions specify that that the drugs are not covered unless patients abstain from drug or alcohol use for a specified period, and some states restrict coverage unless the medications are prescribed by a specialist.

These limitations and others, many health policy experts argue, are counter-productive. The medications, while costly, are ultimately cheaper than treatments complications likely to develop from untreated hepatitis C, including cirrhosis and, ultimately, liver transplants.

Cost concerns are significant, but federal officials have another concern in mind as well: Directing states to offer coverage for these newer, expensive medications could set a precedent for new drugs to treat other conditions — which are likely to be expensive as well. Another potential concern is the stigma attached to patients with hepatitis C, despite the fact that many who suffer from the condition contract it through means other than unprotected sex and usage of infected needles.

Coming competition from newer drugs should exert downward pressure on medications that treat hepatitis C. But for now, the lack of coverage remains a major issue.