HCV POLICY

The AAHIVM Institute for Hepatitis C focuses on policy issues that affect the care and treatment of HCV-infected individuals, and providers in the field. This section contains a roundup of information about state and federal policy efforts, regulations, legislation, decisions, and debates that affect HCV care, treatment, and coverage.

POLICY ISSUES AND HCV

Access to HCV Treatment

Starting in 2014, a new generation of treatments offered hope of a total cure for HCV patients. The introduction of direct acting antiviral (DAA) drugs represented a breakthrough treatment opportunity to cure hepatitis C without the use of interferon-based regimens that had significant side-effects. In addition, cure rates for those using DAA regimens were as high as 95 percent with 12 weeks of oral medication. High introductory market prices for these drugs garnered significant media and public attention, and have resulted in significant challenges for patient access to the medications.

Insurance companies, and government payers (Medicaid, Medicare, and Ryan White) are facing challenges in determining coverage and availability of the drugs. Additionally, some coverage programs have established restrictions to the prescription or coverage of the drug in response to this challenge. Below is a list of some of the treatment restrictions on DAAs that have been put into place by private insurers and government payers:

  • Required drug testing to determine abstinence from alcohol or substance abuse
  • Prescription availability for only patients at a certain (advanced) stage of liver disease
  • Restriction of prescription ability to only certain types of medical providers
Public Policy Issues

Cost is not the only – but it certainly is the primary – factor blocking increases in HCV treatment. AbbVie’s Mavyret, for example, the first pan-geotypic HCD drug to be approved for eight-week treatment, is available at the comparatively low cost of $26,400. Insurers, including Medicaid, have sometimes been able to negotiate private, prior-authorization agreements with pharmaceutical companies for lower prices. This is a very limited solution.

One big step forward would be for Congress to enact a market-based approach, as opposed to the value-based approached that pharmaceutical companies employ in pricing these drugs. This topic was avoided in the Senate health committee’s December 2017 hearing on drug costs, despite the fact that the strategy is explicitly endorsed by the National Academy of Medicine in their report on their making medicine affordable.

HCV Treatment by HIV Medical Care Providers

Medical providers from a diversity of specialties, including internal medicine, family medicine, oncology, and obstetrics-gynecology have played a key role in the medical response to HIV. HIV providers have also traditionally managed the care and treatment of HCV for both their co-infected patients and also mono-infected patients in many cases.

HIV providers have extensive experience managing complex antiretroviral drug regimens in a highly vulnerable patient population and delivering care as part of a team to support the high adherence rates critical to achieving viral suppression. A similar care model and clinical knowledge base is necessary to achieve success with the new HCV antiviral regimens.

In some areas and regions of the country, especially rural areas, the only accessible qualified provider available to treat an HCV-infected patient may be a HIV provider.

Access to HIV providers to treat HCV infection, and to serve as the overall coordinator of care or medical home, is a critical issue for HCV-infected patients.