1. High cost of Hep C drug a barrier to treatment
  2. The cost of the curing Hepatitis C – BBC Newsnight
  3. Measuring Costs For Hepatitis C Treatment
  4. Hidden Secrets of the Uninsured | Shaun Young | TEDxNewAlbany
  5. With highest hepatitis C mortality rate in U.S., Oregon expands access to life-saving drugs
  6. Hepatitis C Treatment Update
  7. Are High Cost Hepatitis C Medications Worth the Price Tag?

High cost of Hep C drug a barrier to treatment

today a Senate report found that Gilead,Sciences which makes a cure for a fatal,form of hepatitis is more interested in,profits than patients the cure was,invented under the leadership of a,celebrated doctor in the Department of,Veterans Affairs but at $1,000 a pill,even the VA cant afford to save the,lives of vets who need it,chip Reid has been looking into this in,2013 Vietnam veterans ioan Israel was,told he had five years to live he has,stage 4 liver disease caused by,hepatitis C which has infected as many,as two hundred thirty thousand veterans,most contracted it in Vietnam where it,was spread by battlefield blood,transfusions and vaccinations the longer,it goes the harder it is to treat after,decades of suffering earlier this year,Israel was overjoyed to learn theres a,cure I felt like my prayers were,answered I am ready to be cured the drug,sophist Bevier is sold as sovaldi and,harvoni and claims to cure up to 99% of,hepatitis C patients but theres a catch,the retail price for a twelve-week,treatment is eighty four thousand,dollars the Department of Veterans,Affairs gets a 50% discount but even,with that the VA told Israel they cant,afford to give it to everyone who needs,it including him come back next year,and then all the time Im thinking about,that well my condition is getting worse,dr. Raymond Shaughnessy founded the,company pharmacy and led the scientific,team that discovered so fast Bevere he,also works for the Department of,Veterans Affairs and has since 1983 he,says hes only a 7/8 government employee,and what he does with his remaining time,is up to him so youre only spending 1/8,of your time on your private companies,well even less than that,even less yes Im very efficient,dr. Shahnaz he made more than 400,million dollars when he sold his company,for 11 billion dollars to pharmaceutical,giant Gilead in 2012 can you see how,that looks to an average veteran youre,taking it personally if youre surprised,that a government scientist can make,that kind of money given federal laws,surrounding conflicts of interest so,were we has anybody ever questioned the,arrangement you have that allows you to,become very wealthy while working 7/8 of,your time with the government,nobodys ever questioned yet I think,Ive done everything Ive disclosed,everything to the VA the VA declined our,request for an interview but approved,the arrangement and in a statement said,federal employees are allowed to invest,in private companies provided all,conflict of interest rules are followed,gilead the company that now owns and,sets the price on sovaldi and harvoni,told us the cost is in line with the,previous standards of care but in this,2013 trade journal dr. Shahnaz II said,it only costs about fourteen hundred,dollars to manufacture the full 12 week,treatment thats less than two percent,of the retail price why is it so much,more expensive than what it cost to make,it thats a good question I mean I think,the price will come down eventually,Zion Israel wonders if the price will,come down in time to save him in the two,years his doctor says he has left its,just not right that the vets would risk,their life and come here and because of,$84,000 you know if you cant get cured,of medication produced by the country,that were protecting dr. Shahnaz ii,says the drug he helped create has saved,hundreds of thousands of lives around,the world but Scott the VA concedes that,funding for US veterans is limited so,far theyve treated about 35,000 thats,just 15 percent of the veterans infected,with hepatitis C chip Reed with a,revealing story in our Washington,newsroom chip thanks

The cost of the curing Hepatitis C – BBC Newsnight

Im waiting for the results might for my,end of treatment results so shes going,to fax them straight through him and,then hopefully you get back to me,Sean reading desperate and unable to get,hepatitis C treatment within the,healthcare system has taken matters into,his own hands,millions worldwide face this dilemma,Ive been making film about access to,treatment for the hepatitis C epidemic,for over a year I found out I had Hep C,in 1998 its highly contagious and can,cause cirrhosis and liver cancer,previously treatment was very toxic now,there are new drugs which cure with,virtually no side effects I live in,Germany where I was prescribed treatment,with the new drug havona,I am now cured Ive come back to the UK,to find out why people here arent,receiving the same treatment as me Im,starting with dr. Andrew hill an expert,in drug pricing if you look at the cost,of these treatments theyre,fundamentally cheap drugs they cost,hundred pounds per course to make that,12 weeks of treatment for one person,that same treatment is being sold in the,United Kingdom for 35,000 pounds so its,just such a huge price that the National,Health Service and nice have been,hesitating theyve been waiting to,decide who should be treated first yet,be on our investigation dr. hill told me,about the US Senates investigation into,pricing which is focused on one,particular pharma company Gilead using,Gilead,own documents the evidence shows that,the company pursued a calculated scheme,for pricing and marketing its hepatitis,C drug based on one goal maximizing,revenue regardless of,the human consequences how many billions,do they need to make before they start,lowering the prices these drugs are,fundamentally cheap but theyre not,being accessed by most people because,the prices are so high one of the,reasons theres so little protest about,the high price of hepatitis C treatment,is that patients are often stigmatized I,went back to see my old doctor to ask,him about this stigma being silent about,hepatitis C is doing no-one any favours,I think there is an incredible amount of,stigma and I think that stigma probably,comes from the days of hepatitis C being,labeled as a disease of intravenous drug,use and of intravenous drug users not,being a useful part of society I went to,see doctor Magdalena Harris who is,researching the experiences of people,with hepatitis C for them a trip to the,dentist is always complicated the issue,of the last appointment Ive been,hearing that for the last ten years in,conducting research for people living a,few potaters see that Im given the last,appointment of the day by my dentist,which is absolutely unnecessary we need,two distinct eyes this and say this is,this is an infection its no different,from any other infection its an,infection that people catch and that,needs to be treated one person who,hasnt been able to access NHS treatment,is Jew Janice nary recently diagnosed,her appointments keep getting postponed,she isnt sure how she was infected with,hepatitis C whats she planning to do,about treatment I dont know I dont,know what what I should do really I am I,suppose I mean Ive been trying to sign,up with trials without any success I,know you can also get her drugs from,India cheaper and I dont know,Julianas life and health are being,badly affected because she isnt getting,treatment ten years ago when I had,breast cancer and stopped the HRT I was,quite fit and well and during the last,ten years I have gradually got worse my,stamina has gone my mobility has been,drastically reduced whereas before I,could walk for hours without getting,tired now I dont Im not able to walk,at all I use a mobility buggy outside,some people are taking treatment into,their own hands and to finding answers,online buying drugs off the internet is,is a new thing its an emerging way of,being treated and one issue is do you,know that the medicine that youre,buying is genuine all these places will,give information for anybody and how to,Shaun reading couldnt get treatment in,Ireland the Irish Health Service like,the NHS cant afford to treat everyone,online he found the Australian based fix,Hep C buyers club through them he bought,clinically tested generic drugs buyers,club I became a member of the buyers,club and had my appointment via Skype,with doctor Freeman,I sent him all my documentation from my,blood test results from Ireland and he,said yes its possible he can if I come,over to Australia I can come to him he,can give them to me,Shaun paid about seven hundred and fifty,pounds for treatment that will cost the,NHS around thirty five thousand pounds I,have now completed twelve weeks of,treatment,last Monday sorry last Sunday night I,went from my blood test on Monday,I am now waiting for my end of treatment,results as we speak,my GP dr. Johnny Fleetwood and Dublin is,on the phone mm-hmm he has the results,of my end of treatment tests and so good,afternoon dr. Fleetwood Im very well,thanks a little bit upper hands of a,nervous but excited at the same time,excellent,Johnny GaN is brilliant news anything,are you go yeah you know Ive lived with,hepatitis since 1980,thats 36 years in the UK it is legal to,get three months treatment delivered to,your door so for those patients who can,pay for it,the online buyers club may be an option,but most will have to wait and see,whether the NHS can afford to treat them,this is billions of pounds in funding at,a time that the NHS is in very difficult,financial situation so it just doesnt,seem feasible that were going to be,able to eliminate hepatitis C within the,next 15 or even 20 years with prices,this high but we could we clearly,definitely could if we could get these,drugs at lower prices that report from,Kate bramble degree asked to speak to,Gilead who you had mentioned there about,the cost of their drugs but instead they,sent us a statement while we appreciate,senator Wydens attention to this issue,we respectfully disagree with his,conclusions both solve our D and harvoni,are deemed cost-effective by the,National Institute for Health and Care,excellence the one-time cost of Salvati,sovaldi or have harvoni pales in,comparison to the lifetime cost,associated with untreated HCV well with,me now virginia executive director of,the association of the British,pharmaceutical industry good evening to,you Devon we know that the drug,companies have to be recompense for the,research the billions they spend on,research do you think theres any limit,to the price they should be allowed to,charge,I think were focusing a lot on price,and what I didnt hear at all,not really you know impactful video was,the value that were getting through the,way these medicines are being introduced,in healthcare and when nice gives an,approval thats not just a tick because,we think its great that its a curative,treatment thats because theyve looked,at does it make sense to spend the,British payers pound on this medicine as,opposed to any other intervention we,could do really carefully so it really,does make sense doesnt it no ones,going to dispute its a great these are,great drugs is really really great drugs,but look lets suppose it has a hundred,thousand pounds of benefit do you think,its reasonable for the drug company to,charge,ninety nine thousand nine hundred and,ninety nine pounds and say look youve,still got a pound of benefit and thats,thats the benefit of an open system,that we have like in the UK where we can,negotiate and lets be honest I mean the,list price that weve been hearing about,is it necessarily whats getting paid by,the healthcare services there is some,very competitive and effective discount,going on wait wait wait wait so we you,think we might be paying less than,thirty five I would almost a guarantee,that with that within the process of the,way we negotiate access Arrangements,under dies and directly with the NHS,that the government does a very good job,of making sure that its being a careful,buyer when theyre investing in new,medicines and lets re

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Measuring Costs For Hepatitis C Treatment

so goal is to look at how the disease,will change especially the cost of,treatment we know that there have been,several issues with the cost payers are,not able to provide treatment timely,treatment of patients with the rising,cost of the drugs so we wanted to know,how much would it cost to the society in,general to treat everybody whos been,diagnosed with hepatitis C and how much,would it cost to make hybrid seƱor ear,disease in the country we published just,early last year showing that Pepsi can,become a rare disease by 2040 around,20-40 and then in this study we looked,at the cost of making reaching that,projection,we start,jacking the disease burn year by year in,2010 before the launch of ba is the the,cost of hybrid icing here was around,seven billion dollars per per year with,the launch of das in addition to the,expansion in the insurance coverage,because of Affordable Care Act plus,because of the impact of screening,updates the cost of heaven se kare,jumped to 22 billion this year in 2015,from seven billion in twenty ten to,twenty two billion this year and 17,billion were spending on treatment this,year,number of factors medications are more,expensive number of people were training,or is very large number of people who,are aware of the disease is large people,who have insurance now has increased so,multiple factors,for patient care I think if theyre,getting care doesnt mean much its a,good thing for them its all wonderful,because they can get cured of the,disease to the health care system it,means a lot because we still are not,able to treat everybody who has been,diagnosed with hepatitis C so we have to,further increase our treatment capacity,how do we do that by removing,restrictions for example Medicaid has,restrictions on who can get treatment if,patients are their history of active,injection drug users they are not,reimbursing for drugs so removing these,restrictions will definitely help,earlier in the year we saw that several,the other pairs were also restricting,treatment based upon the fibrosis a,degree of the disease severity people,who are more advanced you can get,treatment wearers less severe should not,right now they should wait so we have to,remove those restrictions,there are a lot of issues with that,because I think our system is not,prepared for this Medicaid for example,did not have budget they do not have,allocated budget to treat everybody they,would anticipate getting drugs next year,so they decide them Buzzard one year in,advance similarly V is where the,prevalence is also very high veteran,affairs they did not plan for this very,well so because of these factors there,is a restriction on the budget how much,they can allocate to have rat asleep,that means they have to remove budget,from some other areas and put then,hepatitis C so thats probably one of,the limitations of the system,what would be the reason if the reason,is that they dont have insurance then,what Ive heard is several,pharmaceutical companies are providing,system programs they can approach them,to get treatment if the patient is,Medicaid on Medicaid and Medicare is not,reimbursing so thats very unfortunate,situation I dont know what to say to,the patient but since I patient would,have to wait and maybe a year or so at,least when the more budgets available,these patients are treated,can cost may not,some discount be pairs are giving,getting discounts because of the,competition now so practically there has,been some impact though the listing,price remains the same and that eighty,to ninety thousand dollars but,practically what we are paying is much,lower than what we saw last year when,the drugs were approved but what whats,interesting finding of our analysis is,that the bottom is declining very,sharply in the next few years for,example by 2020 the budget the total,spending on hepatitis C would be below 5,billion dollars because we would have,treated most of the pigeon big number of,patients who need these therapies then,by 2030 thats when we anticipate,generics would become available in the,u.s. we would have traded most of the,patients and they would not have any,impact on the cost of here,another,objective of our study was to look at,how much would it cost to make this,disease rare and it found that its,totally 101 or six billion dollars which,is substantial amount of money but if,you compare that with HIV spending in,the last five years only we spent 140,four billion dollars on hiv/aids so and,this with several 37 public that show,that number of people dying from hybrid,AC in the last few years is more than,that from HIV,so one of the limitations of this work,was we did not include the,institutionalized population the people,who were in presence homeless population,the business burden is very high in this,in these two populations so how do we,bring these people into the system and,then who pays for their treatment so,thats a big crash,before,for da is we found that number of I,rimac people people who are hiv-positive,and still need treatment was around 2.4,billion dollar sorry 2.4 million and,then in this year 2015 we projected that,around two million people need treatment,and moving forward by 2020 less than 1,million people would need treatment and,then we also looked at how many people,are aware of the disease in this year,and then how would that would change in,your future we found that around 900,000,people in this year still dont know,they have hepatitis C and human in the,next five years in spite of the,screening updates since training,policies for hepatitis C by 2020 we,still anticipate half a million people,would remain unaware of the disease,the message here we project is that,theres no doubt das would do very good,in reducing that is this burden but the,burden still remains very high even in,the air of DA is because we now,essentially have a cure of a disease and,still we see that many people would,advance these adverse outcomes like,liver cancer Doug and I could die from,hepatitis E,so we need definitely need better,screening and then how do we provide,treatment those people who would be,diagnosed with a bracing another,population thats growing is number of,people who achieve sustained virologic,response which is the surrogate of cure,for hepatitis C however many of these,patients would still be at high risk of,developing hobart a cell carcinoma so we,need active surveillance and these,people otherwise they could many of them,could advance to hcc or diaphragm liver,disease,hidayat its for everybody because there,if now we calling them peach patients,are cured they were not calling a,patients anymore there so they may not,be going to have a dollar is regularly,so they made me go into general,practitioner so they need to be aware of,this population because they still am I,risk,well we hope that we would have treated,majority of patients who were aware of,the disease even lie we would have,diagnosed more and more patients in the,near future and we hope that it will not,be a serious disease anymore

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Hidden Secrets of the Uninsured | Shaun Young | TEDxNewAlbany

you,I want everyone to close their eyes and,picture someone whos uninsured what do,they look like how old are they what do,they do now open your eyes is this who,you had in mind well I certainly did,until my first day as a pharmacist,thats me,many many many years ago you see it was,like any other first day came in with a,lot of hope and a belief that I could,change the world one person at a time,and it was tested that first day in fact,in that first hour when a woman came in,with the prescription for her daughter,you see she didnt have insurance and,the prescription came out to forty,dollars and she didnt have $40 for that,prescription so being new I thought hey,I can help here so I took out $40 and,paid for her prescription the mom was on,the verge of tears the daughter was,grinning from ear to ear and I felt like,Im really making a difference that was,until the next person came in and didnt,have insurance and couldnt afford his,prescription and the next person and the,next person and the next person after,that you see I learned two things on,that first day one Im gonna go broke,being a pharmacist and two this is not,who I pictured when I thought of someone,that was uninsured every person I met,was a hard-working American part-time,hourly self-employed and for whatever,reason they didnt have insurance that,they also planted the seeds for my,lifes work which is to make health care,affordable for everyone you see at this,point I can probably rattle off stats on,how healthcare is growing five times,faster than inflation how the average,family of four pays more in health care,premiums than they do in their call in a,new car every year and how medical bills,are the leading cause of personal,bankruptcy but instead I want to talk to,you about the uninsured because all of,us talk and hear about the rising cost,of health care but the uninsured have to,deal with it head-on because they pay,for it all out of pocket,and in fact I think the uninsured have,secrets that can teach us on how to,control the rising cost of health care,so fast forward to today in 2016 theres,still 29 million uninsured Americans,fear baristas your stylist your personal,trainers your freelancers your uber,drivers your distribution workers your,cleaners so your grad students maybe,even some of you in the audience are,without insurance you see every time I,meet someone thats uninsured I ask them,two questions why dont you have,insurance and well what do you do if you,need health care to that first question,why dont you have insurance everyone,gives me the same response its a math,equation that I want to share with you,theres a cost of health care and then,theres a cost of health insurance you,see theyre young and healthy but they,may get sick they may get a prescription,they may need to see a dentist and eye,doctor maybe get some contacts or,glasses I estimate they spend about $500,a year on health care now if that same,young healthy person doesnt get,insurance from their employer they have,to get on the exchange where they spend,about two to three hundred a month on,premiums and a seven thousand dollar,annual deductible I estimate they may,spend about ten thousand dollars a year,on health insurance ten thousand versus,five hundred any way you cut it the math,just doesnt work out so it makes sense,why they would go without insurance but,the real interesting question is what do,they do when they need health care I,spoke with one gentleman and he said it,best he says I cant afford health,insurance but I also cant afford to get,sick so I exercise I eat right I wash my,hands I get enough sleep I mean really,basic things but I wasnt satisfied so I,probed a little further and I asked well,what did you do the last time you were,sick and you have to think about it but,then he said well I guess I went to the,retail clinic its affordable its,convenient many pharmacies have,prescriptions for four dollars or even,free antibiotics and anytime I need to,see a doctor a dentist get an x-ray I,always ask if theres a discount for,paying cash and they always say yes,let me break down the two things he does,that could be a powerful formula for,controlling the cost of health care,personal responsibility and shopping for,health care he cant afford to get sick,so he does everything he can to avoid,getting sick but in the unfortunate,event he does he actually shops for his,health care at this point I want to make,sure no one misinterprets what Im,saying I am NOT encouraging anyone here,to drop your insurance and go on insure,it no instead I want to challenge,everyone here to think of your health,insurance the same way you think of,other forms of insurance to protect,against catastrophic risk fire insurance,flood insurance car insurance we have it,in case something bad happens I bet no,one here is gonna leave the auditorium,today and go home and cant wait to get,into a car accident so I can finally use,my car insurance no we have it in case,something unfortunate happens but with,their car insurance we fill gas we,change our oil we rotate our tires we,wash our cars I bet many of us take,better care of our car than we do our,bodies you see health insurance has,instilled a help me fix me mindset,whereas the uninsured have a help me,help myself fix myself mentality because,theyre paying for everything out of,their own pocket,you know I counted in my life Ive been,uninsured seven different times I have,what you might call career ATD I change,jobs every year or two and every time I,change jobs I lose my coverage into my,new employer picks it up and when I was,a graduate student I was uninsured I,just couldnt afford health insurance,but I did what that guy did I exercised,I ate right I washed my hands and I do,remember taking a lot of,over-the-counter drugs but today I do,have insurance but my wife said it best,yeah we have insurance but with a seven,thousand dollar deductible were not,covered so I want to share with you what,I did the last time I needed health care,I was training for the Columbus half,marathon and one afternoon I came back,took off my,and realized my toe was red and swollen,so I jumped on my laptop Google would my,toe is red and swollen from the cold and,I realized its something called,chilblains Ive never heard of,chilblains before so I went on WebMD at,this point I want to pause and,acknowledge every doctor in the room is,probably cringing when they hear what,Im doing but this is the reality of a,21st century underinsured patient so,WebMD said that I probably need an,antibiotic because its infected I,realized it wasnt urgent so rather on a,Sunday night I stayed home but first,thing Monday I went to the nearby retail,clinic went right in friendly nurse,practitioner asked me questions them and,my toll gave me a prescription that I,filled next door all in less than an,hour and under $100 had had gone to that,urgent care on a Sunday night and maybe,a 24-hour pharmacy I would have spent,$500 not to mention the hours of wait I,say $400 by shopping for my own care,because frankly I need to make sure to,stay healthy so I dont need health care,I want to go back to the top of my story,and revisit that mom I paid for a,prescription then but had I known then,what I know now I wouldnt have paid for,that prescription instead I would have,called a couple of different pharmacies,see if any one was cheaper maybe even,contact the doctor and see if there was,a cheaper alternative you see Im a dad,myself and no kids dont just get sick,once and had I taught that mom how to,shop for her health care despite being,uninsured she could probably continue to,provide health care for her family going,forward today 750 billion dollars a year,is spent on waste in health care 30% of,all dollar spent in Health Cares,unnecessary tests unnecessary procedures,unnecessary visits I imagine if you were,uninsured and you have to pay for,everything out of your pocket would you,ask that doctor do I need that test,would you ask that pharmacis

With highest hepatitis C mortality rate in U.S., Oregon expands access to life-saving drugs

JUDY WOODRUFF: Now: the latest on a medical breakthrough thats starting to have an impact,on a hidden, deadly epidemic in this country.,New drugs can cure up to 95 percent of patients with hepatitis C, a virus that often leads,to debilitating or deadly results.,The drugs can save lives, prevent expensive hospitalizations and liver transplants.,But some states are feeling the squeeze of the cost of this medicine.,Special correspondent Cat Wise has our report for our weekly series on the Leading Edge,of science.,CAT WISE: Three-point-five million Americans are living with a potentially deadly virus,,and half dont even know it.,Its hepatitis C, a blood-borne pathogen which attacks the liver and can eventually cause,serious liver problems, including cirrhosis and liver cancer.,Three-quarters of those with the virus are baby boomers, exposed from unscreened blood,transfusions, I.V.,drug use, and other blood-to-blood contact prior to the early 90s.,But now the opioid epidemic has led to a 20 percent rise in new infections from 2015 to,2016.,One state where the young and the old have been hit hard by the disease is Oregon.,Oregon has the highest hepatitis C mortality rate, per capita, in the country.,Its estimated about 100,000 Oregonians have been infected with the virus and more than,500 die every year.,Its been a very difficult disease to treat, but over the last four years, theres been,a revolution in hep C drugs.,Many are being cured around the country now, and here in Oregon, many are coming here to,the Oregon Clinic for those treatments.,DR.,KENT BENNER, The Oregon Clinic: We never talked about cure of hep C until the last few years,,and now were all talking about cure of hep C.,CAT WISE: Dr. Kent Benner is a gastroenterologist and hepatologist at the clinic in Portland.,He says people are still dying from the disease, often because they havent been tested and,arent aware they have virus until they are quite sick.,But Benner says much has changed since he first started treating patients several decades,ago.,DR.,KENT BENNER: Treatment at that time was interferon.,This required injections, shots several times a week.,Quite a few side effects.,We felt we were doing well if we could cure 15 or 20 percent of patients.,Since late 2013, theres been a remarkable development from a number of different companies.,They have developed drug combinations that provide 95 percent cure rates in patients,we treat.,CAT WISE: Costly liver transplants are often the only option when the liver becomes too,badly damaged.,But at earlier disease stages, the liver often starts to heal once the medicines have cleared,virus from the body.,DR.,KENT BENNER: Not only are we seeing liver function improve, but patients with more advanced,liver disease occasionally can come off the transplant list.,CAT WISE: Sixty-four-year-old Rob Shinney, who recently had knee surgery, is one of those,cured by the new hep C drugs known as direct-acting antivirals, or DAAs.,Like many others of his generation, he doesnt really know how he contracted the virus.,Under the care of Dr. Benner, Shinney began a three-month treatment in late 2016 after,his liver showed signs of moderate scarring known as fibrosis.,Tests later confirmed he was virus-free.,ROB SHINNEY, Patient: I had a serious chronic illness hanging over my head that I knew could,kill me.,And thats gone now.,CAT WISE: We spoke at a local pub he visits now and again with his choir friends, something,he never did when he had the virus.,ROB SHINNEY: I swear I felt like I was 20 years younger.,I had energy.,I could do things.,Its great just to be able to sit around and have a beer with everybody and, you know,,just enjoy life.,CAT WISE: The cost of the drugs used to cure Shinney, who has private insurance, arent,cheap.,Since Gilead Sciences Sovaldi first hit the market in late 2013 at a whopping $84,000,for a course of therapy, competitors have steadily lowered the costs.,Last year, a new medication called Mavyret was released for around $26,000.,Many payers often, though, negotiate even lower prices with the drug company.,Still, the drugs are expensive, and they arent a vaccine.,If someone is cured, they can become reinfected.,Access to the drugs varies widely around the country.,A report last year by two national advocacy organizations found that many public and private,payers choose to limit access to DAAs due to their cost, as well as other concerns.,Oregon is among a number of states which have had restrictive Medicaid requirements, including,denying coverage to patients in the early stages of disease and those who are abusing,drugs and alcohol.,But some of those restrictions are beginning to ease.,DR.,DANA HARGUNANI, Oregon Health Authority: In January, we just started covering individuals,with lower stages or lower levels of fibrosis.,CAT WISE: Dr. Dana Hargunani is the chief medical officer for the Oregon Health Authority,,which oversees the states Medicaid program.,She says, while the state is starting to expand access, costs are still a significant issue.,Oregon has spent more than $94 million on the drugs since 2014, covering about 1,500,people.,DR.,DANA HARGUNANI: The newer treatments for hepatitis C have a significant budget impact for our,state.,We had to get additional funding through the legislative process.,Were trying to manage our limited resources to ensure coverage for those who need it immediately,for the hepatitis C treatment, as well as all the other individuals in our Medicaid,program.,CAT WISE: Hargunani says another reason the state delays coverage until patients have,mild liver scarring, not everyone needs the medicines.,DR.,DANA HARGUNANI: One in five individuals who get infected with hepatitis C will spontaneously,clear their infection.,Right now, the data doesnt help us understand how to know which individuals will need to,have a high-cost drug to treat and cure their infection.,DR.,BRIANNA SUSTERSIC, Central City Concern: Luckily, he doesnt have any evidence of cirrhosis.,CAT WISE: Dr. Brianna Sustersic is a medical director at Central City Concern, a federally,funded health center in downtown Portland which serves a large number of homeless individuals,,many of whom have substance abuse disorders; 25 percent to 50 percent of the patients have,hep C.,DR.,BRIANNA SUSTERSIC: The Medicaid requirements have limited access to treatment for many,of our patients.,From a public health standpoint, if we are able to treat the population who is contracting,this, and spreading it, then we can move toward eradicating the disease.,CAT WISE: To prove that point, and to meet a big need, the clinic and a local syringe,exchange program began a small drug company-sponsored study last year to treat patients who otherwise,wouldnt have qualified for the medications; 56-year-old Kim Trano is now virus-free thanks,to that trial.,She says shes felt a lot of stigma being a recovering drug user and it was hard to,learn she had initially been denied drug coverage.,To those who would question giving expensive medicines to someone who might become reinfected,,she says:,KIM TRANO, Patient: Everyone is worthy of a chance.,If I were to relapse, I would all precautions not to be reinfected.,And thats pretty easy to do.,Most people know how to do that.,CAT WISE: The new medicines combined with the big surge in those looking for treatment,has led to a unique care model.,Chris Hulstein is not a doctor.,Hes a clinical pharmacist and part of a new program at Portlands Providence Hospital.,Over the past year, about 50 patients have been successfully treated by Hulstein and,his colleagues.,Another 30 are currently in treatment.,CHRIS HULSTEIN, Clinical Pharmacist: A lot of the specialists are very busy managing,very complex patients, and that is their role.,Having a pharmacist being able to manage the patient gets patients treated faster and more,successfully than we ever have been able to do before.,CAT WISE: Hepatitis C advocates are now working with

Hepatitis C Treatment Update

[Music],welcome this is brian wood medical,director for the mountain west aetc,project echo telehealth program,each of our weekly sessions starts with,a short talk focused on issues relevant,to hiv clinical medicine,the following talk was recorded live,here at university of washington we will,now take you to this weeks talk,[Music],great thanks hillary and welcome,everyone so this is gonna be a two-part,series im gonna cover some of the,clinical aspects of hepatitis c some of,maybe some new things you may not have,seen and then next week david hatchy is,going to talk about some of the common,drug drug interactions,so if you have questions like that i,mean you cant wait maybe ill call on,david in that area so just a little bit,of my disclosures here none of them are,relevant to todays talk but i tend to,over disclose,so what i wanted to do is briefly just,give a quick epidemiology update because,that has changed in the last couple of,years and then move on to some of the,new practice guidelines from the double,asld and idsa hcv guidelines,talk about what to do when people,have interruptions in their hcv therapy,and then wrap up with this question,about pregnancy and acv therapy,so just a little bit of the background,about hep c,and this is data from the cdc is that,were seeing more cases of hepatitis c,both in acute hepsy and chronic hep c,so this first study was reporting over 3,000 cases of acute hep c and i think,thats probably a massive underestimate,because it can often be occult and not,recognized so we think that there are,more likely to be somewhere around 50,000,new cases of hepatitis c every year,and this is a three-fold increase over,roughly the last 10 years from 0.3 in,2009 now to around 1.2 per hundred,thousand,and you can kind of see that its not,all age groups that are being affected,this is part of the whole opioid,epidemic so,younger folks are be more affected than,other age groups so this biggest line,here,is the 20 to 29 year old age group and,then followed pretty closely by the 30,to 39 year olds,the one thing i will point out is there,still is some increase in the other age,groups and i think that is also a,reflection of injection drug use,particularly with opioids,so this next slide shows where we are,with the chronic hepatitis c and if i,were to show this slide 10 years ago it,would have been a kind of a classic just,peak in the baby boomers so those folks,who were born between 1945 and 1965.,so it was kind of like that one humped,camel now were were looking at a,two-humped camel and what you can see is,that the,younger folks so,folks between approximately 24,to mid 30s,represent the most number of cases,theyre now surpassing the baby boomer,cohort,and just a little bit about how its,impacting mortality is it was the number,11 cause of death in 2017 which is i,think the most recent,reliable national data that we have,representing approximately 17 000,deaths and this death rate is around,four per hundred thousand but its often,listed as an underlying cause of death,and deaths in which theres not the,primary cause so 29 percent listed hcv,is underlying cause of death,and in those cases where theres like a,liver-related cause of death its its,like hcc,alcoholic cirrhosis or some other kind,of neopos in the liver so we think that,this is probably contributing there the,good news is this is declining probably,reflects some of the newer antivirals,that have started coming on board in the,mid 2010s,if you look at which states are most,affected by hcv mortality i just want to,draw your attention to the pacific,northwest where both washington oregon,have some of the highest age-adjusted,mortality and then also the southwest so,new mexico texas and oklahoma and a,little bit here in d.c,so this is still an issue even with some,great antivirals out there were still,not out of the woods,so i want to turn from the epidemiology,now start talking about some of the,changes the asld idsa guidelines and,just a disclosure that i sit on that,committee and dont speak for them today,but i just want to let you know some of,the changes that weve made,and overall i think there was just a,push to make the treatment guidelines,simpler and streamlined theres a bunch,of medications that were just theyre,not longer being marketed or rarely used,so weve tried to take some of those out,so theres updates on how to order your,workup labs how to monitor patients,while theyre on therapy and then what,what to do with vosavi or softwall box,failures,so the initial labs and work up are,listed here in the green box,and just a kind of a simple thing you,should be doing and usually this is a,couple tubes of blood get a cbc,a liver function test nine our,creatinine so i think theyll probably,give you,three tubes of blood,and from that you can calculate both,the asc to platelet ratio or opry,or something called the fib four so the,fib4,is very similar to the apparatus using,the ast and platelets but it does take,into account the age,and so ive seen a couple people,have maybe a really low opry or a very,high opportunity but then when you do,the fib 4 it gives you a little bit,different information so if i had to,choose between those two,i would use the fib for and this,information is available on the acv,online website if you wanted to you know,bookmark that and be able to get to it,quickly in my office where i have fiber,scan available almost everyones getting,that otherwise known as transient,elastography,it takes about five or ten minutes just,a,sound wave that my staff is trained to,do and and i do it as well,but it is is very accurate about ninety,percent sensitive for picking up severe,fibrosis and i like to use both the fib,four,and the transcendental osteography,because theyre a little bit different,test,if you didnt have fiber skin i think,the next best option would be fiber,short thats a blood test it costs,around 250,i will just warn you that in my,experience for the last like five years,its probably the least accurate ive,seen it overestimate and ive seen it,underestimate,so if you get something wacky its,usually the fiber shirt thats not right,and then if if you wanted a tie breaker,sometimes imaging is helpful you do not,need to get ultrasound on everyone,thats not necessarily often will add to,your costs and not really help you that,much in your work up and then liver,biopsy is still the gold standard so if,you have maybe some,tests that are contradicting themselves,say that your fit four was really low,and the fiber scan is high youre not,really sure what to do that might be a,situation where you want to get a liver,biopsy,so in addition to those tests the other,thing you want to get on your initial,workup would be urine pregnancy tests,especially if the womans of child,bearing age just want to make sure that,they do not get pregnant while on,therapy,and then kind of normal things many of,you guys already already know the hiv,status but if you dont get hiv and then,hepa and b serologies,so the asld guidelines now have a very,simplified hv therapy and this is for,someone who has no cirrhosis,you would basically your two options are,going to be,glycopreprimbrandosphere or maverick for,eight weeks,or sophosphere vapours for occlusa for,12 weeks now someone who would not,qualify for a simplified therapy as,someone whos been treated before with,the daa and failed,and then well go over cirrhosis on the,next slide anyone whos hiv or surface,antigen positive and theres some,considerations there with drug,interactions,current pregnancy,known or suspected parachute carcinoma,or prior liver transplant those tend to,be,managed more in a specialty situation so,what about cirrhosis its its basically,the same thing,and the only thing i would warn you,against is using an hcv protease,inhibitor in anyone who has childs,class b or c,so maverick does have that protease,inhibitor if their childs a you can you,can treat them,i just say probably watch them a little,bit more cl

Are High Cost Hepatitis C Medications Worth the Price Tag?

in late 2013 to drugs were approved by,the FDA to treat chronic hepatitis C,virus one of these agents with saval d,the third drug receiving breakthrough,therapy designation from the fda the,breakthrough therapy was the first drug,approved to treat chronic hepatitis C,without the co-administration of,interferon a drug with numerous side,effects that often led to non adherence,with treatment regimens unfortunately,along with this new treatment regimen,comes a hefty price tag thousand dollars,per day or eighty four thousand dollars,for an average duration of treatment,thats not including the cost of,co-administration of ribavirin and,possible interferon savall DS launch was,thought to be the biggest in history and,has already been used to treat,approximately a hundred and seventeen,thousand patients suffering from chronic,hepatitis C Saval D has demonstrated,higher than ninety percent cure rates,associated with its use but is this,worth the costly price tag with that,ninety percent curate curate stacy is,that price tag worth it well I think to,say that this of all the example is a,very unique case study is certainly an,understatement theres really no doubt,that its very expensive but its sort,of interesting to think about it if it,wasnt a drug that cured the virus in 12,weeks but instead was used over 15 years,to suppress the virus and potentially,reduce and end-organ damage at a cost of,fifty six hundred dollars a year over 15,years we would think of it much,differently however thats not the,reality the reality is eighty-four,thousand dollars in 12 weeks hitting,budgets in a particular budget year and,I think thats really one of the ways,thats made this discussion so unique i,think the other real issue that we see,with the hepatitis C treatment,population is the sheer numbers the CDC,really estimates that approximately 3.2,million Americans have hepatitis C so,certainly in the specialty space were,used to dealing with very high cost,drugs we see high cost drugs all the,time but we typically see them in,orphan disease states more theres very,few patients across the country being,treated and the issue with this is that,we really have a tsunami of patients to,be treated that are hitting payers all,at once with this incredibly high cost,so I think those are a couple of things,that really make this of aldi and the,hepatitis C example very unique within,this past year I was thinking that it is,worth the price tag for some patients,but maybe not all patients so its,important to understand the hepatitis C,is a very slow progressing disease and,then all patients are going to end up,with cirrhosis or liver transplant so,the CDC estimates for every 100 patients,that infected with chronic hepatitis C,but 60 to 70 of those will go on to have,liver to liver damage but only five to,20 will actually develop cirrhosis and,and may and which may lead to liver,transplantation or liver cancer so when,you think about that you know should all,of the patients that have hepatitis,Sierra infected be treated with these,drugs we know it is a cure for every,patient but if not every patient is,going to go on to develop cirrhosis and,have these you know severe effects of,the disease it really makes you question,it and I know recently I read that a,large portion of the patients I believe,there were fifty percent or more did not,have advanced disease that were treated,with civ all d of those hundred and,seventeen thousand patients so I think,you know as new therapies entered the,market place i think you know payers,need to be thinking about you know which,patients are the most important to treat,do we need to treat all of them and is,that the way would that we can afford,the treatment for those that you know,really do need it very good any other,comments you know becomes a very,challenging dilemma and really specialty,pharmacies is somewhere in the middle we,do a large portion of hepatitis C and,you know one particular Medicaid area,the state Medicaid program we had,they had not approved the drug in the,beginning of the year and they were,trying to make it go through formulary,and you know figure out how theyre,going to handle it well it turned out,that we had ninety percent of those,referrals where were sending from my,organizer or our organization so we went,down and we met with the state Medicaid,program and when you hear the program,tell you that if they approved every,authorization thats out there they,would spend the whole years budget and,and how do you balance that how can a,program pay for the hepatitis C patients,and that everyone else who needs a medic,a prescription the fundings not there,and then the other interesting we met,with another large player in the midst,mehdi space and they looked at their,claim data and said what we only did for,we only paid for fortran liver,transplants last year how much is all d,really helping our organization in our,patient population so i think,appropriate use is something important,with these with these higher cost agents,thats an eye opening statement that you,got from the state that was a meta,believe its kinda thats thats the,dilemma in the challenge it can even,commercial health plans are facing we,all know that patient affordability is,as a barrier to start a therapy and in,fact if the co-pays are high enough it,could be actually a denial for that,patient to get treatment is that an,issue with the with the Hep C drugs are,we seeing high co-pays and patients are,you know essentially not being able to,get therapy because of affordability,issues any thoughts at our organization,were for the commercial patients were,not seeing that the manufacturers are,supporting copay offsets and those are,being effectively applied so were not,seeing that but in the non-commercial,you know those government payers we are,seeing patients who do have financial,barriers in that regard were leveraging,the funding organizations penn ave path,cdf to help,appropriate utilization its great,especially pharmacy does that yeah,absolutely i think you know if you look,at in our organization the the cost,barrier is really almost nil in this,space theres plenty of funding we work,directly right with the liver,foundations and and there theres the,opportunity to once the patient is,approved you know the co-pays not,usually a limiting factor and of course,with the Medicaid population if they do,get approved you know again the copay is,not an issue harvoni was approved by the,fda in october for the treatment of,hepatitis c patients with genotype 1 the,combination drug is manufactured by the,same organization as savall d harvoni is,a combination ns5a inhibitor and a,nucleotide analogue ns5b polymerase,inhibitor this once daily drug is,demonstrated efficacy with consistent,SVR rates above ninety percent in,addition to this newest agent several,other hepatitis C drugs are expected to,appear in the marketplace soon Renee do,you believe this competition will lead,to decrease costs within hepatitis C yes,and no so harvoni came to the market the,first oral agent it combines two,antivirals as we mentioned its a once a,day treatment and it was FDA approved,for shorter treatment duration so some,patients can actually qualify to use it,for eight weeks which offers a little,lower price and then other patients,standard pretty much as 12 weeks and,then the worst patients 24 weeks there,are other competitors ready to come to,the market one of the competitors a BMS,product pulled their application because,they couldnt achieve SVR rates close to,where her body was the next competitor,ave products its questionable as to,whether or not it will come to the,market approved without the use of our,brevard and that particular product,contains three antivirals if it is,approved with the use of ribavirin,patients will have to take multiple,tablets and some of them twice a day,which we may make adherence an issue,so in order to have competition in terms,of decreasing the price to harvoni these,pr

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