1. Louisiana Is Getting an Unlimited Supply of a $24K Hep C Cure (HBO)
  2. With highest hepatitis C mortality rate in U.S., Oregon expands access to life-saving drugs
  3. Mavyret Treatment: Day 5
  4. Hepatitis C Treatment Update
  5. RxOutreach: Making medications affordable (April 2021)
  6. Accessing HCV Medication Through Insurance
  7. Treatment of Hepatitis C 2017: Easy to Treat, Easy to Cure!

Louisiana Is Getting an Unlimited Supply of a $24K Hep C Cure (HBO)

okay,Damien Belen is used to doctors Damien,has hepatitis C a chronic liver disease,spread through blood he got it from his,mom he was 12 when he found out its,like a little shadow thats behind you,you dont know how to tell people Hep C,is quietly the most widespread,infectious disease in the u.s. affecting,more than 2 million people and because,its easily spread through shared,needles the opioid epidemic means its,getting worse,hows it going good to see you Im gonna,go over your last lab but first how are,you doing theyre good yeah working hard,you know slinging those drinks treat and,cure you as soon as possible you gotta,enjoy those drinks as much as possible,Damiens dr. Jason Halperin is an expert,in infectious disease he sees patients,five times a week at a clinic how urgent,is the Hep C crisis in the country its,incredibly urgent people die of Hep C,more than any other infection that,exists in the United States the HIV TB,influenza so it is of urgent need to,treat and cure,when Damien was diagnosed there was no,cure but in 2014 the pharmaceutical,company Gilead released a groundbreaking,drug its the one and only cure thats,one pill once a day for 12 weeks only,Damien cant get it because hes not,sick enough so here is the letter,January 22nd 2019 denial notice it has,many many pages but the only thing that,really matters is this first sentence,and UnitedHealthcare communion plan will,not pay for the care the medication is,so expensive Medicaid has had to ration,the pill treating only people whose,livers are already damaged by Hep C or,he could pay out-of-pocket with a price,tag of 91 thousand dollars,its Louisiana Health Department with,its strapped state budget making the,decisions on who gets treatment but dr.,Rebecca key the state Secretary of,Health thinks the disease can be,eliminated entirely and shes been,trying for three years to get a better,deal here we have a cure for an,infectious disease this should be a,solvable problem but its not because a,drug is too expensive so she got,creative she dug up an obscure 1910 law,that gives the federal government the,right to use any patent as long as it,pays the holder a reasonable price so,you considered taking away the patent,from the Hep C makers well we asked the,question not surprisingly the,pharmaceutical industry was less than,enthusiastic sure about this idea so we,said okay what else this time he would,negotiate with pharma but changed the,terms for one set price should get,unlimited drugs for people on Medicaid,and in prisons what we came up with why,dont we spend the current price up to a,cap that we pre negotiate so thats our,subscription price and then after that,price we get rebated back 100% of our,spend the pricing scheme worked in,Australia in 2015 since Louisiana,suggested the idea Washington State has,also followed suit,how much did Medicaid spend on the Hep C,Kara last year so last year we spent,around 30 million 30 million dollars how,many people were you able to treat about,300 but lets say you had the,subscription model how many people could,you treat our goal would be ten thousand,people next year,all three manufacturers of Hep C drugs,responded to the states request for,proposals shes been in talks with,Gilead to settle on a price for the,generic version of their drug at,cluesive it really wasnt until there,was more competition in the market that,we were able to get some traction whats,it like to negotiate with a company like,Gilead,what power do you have to really,negotiate with them yeah I mean we have,the power of our state spend on drug,pricing but it really is a David and,Goliath,and we are David any negotiation if you,cant say no its its not really truly,a negotiate,the deal should be a win-win sales of,Hep C meds are down in this contract,with locked in a market for five years,still the June first target date to get,an agreement came and went the,for-profit drug industry is extremely,difficult to change because theyre,for-profit they have shareholders and,those shareholders want to make money,youre not offering up enough money is,that whats happened well we just dont,have it and what would I say to somebody,who says well its just not fair that,youre not treating everyone I would say,to them you know it would cost me seven,hundred and fifty million dollars to,treat everyone in Medicaid and that,would take away my K through 12 budget I,mean what do I do you tell me this week,doctor G in the Health Department,finally broke through with Gilead and,reached a deal it isnt everything dr. G,hoped Louisiana is paying a lot more,than they did last year but starting,July 15th the state will have unlimited,access to the cure,for five years and a big incentive to,treat as many people as they can,Gilead goes through with the deal arent,Gilead the people that created this,problem yes the fault is on the drug,companies because theyre pricing so,high but mostly I blame policymakers,because its our policies that allow,these drugs to be so high this model is,an example of a voluntary agreement one,where a company and a state agree to you,know without having to regulate it we,asked Gilead if the company bears any,responsibility for making the drug so,expensive and they did not respond to,our question what does it tell you about,that the landscape of the negotiation,market that even though you have all,this support you still cant fully force,the prescription drug companies to to,play ball yeah I mean the rules are,stacked against us the idea is you know,Pharma why should you care right so,right now we give you this money and we,get restricted access why do you care if,were going to treat someone who cost,you dollars a pill you know why does it,matter to you if were gonna treat,someone,in Medicaid whos not getting treated or,if were going to treat someone in jail,youll never make that money yeah so,what is it to you that we treat them and,we save their life,[Music]

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

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Mavyret Treatment: Day 5

[Music],everybody day five this is day 5 of my,maverick,you see that maverick treatment matte,red is a medication for hepatitis C it,takes hepatitis C and destroys enough of,the virus in your body so that your body,can naturally finish fighting it off,fortunately I went to the free clinic,here in Columbia South Carolina and I,was able to get this treatment which,cost some like 484 pills its $13,800,they dont know insurance covers it and,recently they made it where people can,take this get this vacation for free,through the company the company gave it,to me basically because I have hepatitis,C genotype 3 which is what member it is,for Mavericks for treatment I think of,all six genotypes of it but I didnt,have any liver damage which is really,fortunate and Im able to get treatment,be cured of hepatitis C and if youre,watching now youve seen the first four,days of foot what you didnt see the,first day and the reason for that is is,that as soon as I hang the medication I,took my first treatment right at the,free clinic because I was so excited,about getting the medic medicine because,Ive had hepatitis C for quite some time,and been trying to get this treatment so,anyway without further ado and Ill be,doing this every 7 days Ill put a vlog,of my treatment out for everybody to see,and itll be of all seven days the next,seven day said well you will have all,seven days including the first day of,today 14 and youll get this entire,treatment on and if youre taking,maverick or,thinking about getting it there is free,help out there for anybody who is,interested in that that has hepatitis C,there is free help out there you can go,through Im sure that in your town you,can go through the free clinics in,Columbia if youre in South Carolina or,in Atlanta if youre in Atlanta the free,clinic will hook you up with the,Maverick company who will give you the,medicine if you have that genotype or,even if you dont oh you can get harvoni,for free theres numerous treatments out,there for people with hepatitis C now,and if youre not going and getting the,treatment youre foolish go get it dont,die its not stupid thats not smart,live your life out thats what Im going,to do if I have a chance to do it thats,what Im going to do so anyway heres,day five theres the pills Im gonna pop,them out and take them lay my phone down,for a second and this one this video,heres a little bit longer than the,other little clips that Ive made in the,last few days because I didnt give you,guys as much explanation like this I,wanted you to kind of see what Im doing,and feed your interests and make you,wonder what the heck Im taking this is,what it is medicine to get rid of a,noxious disease is killing theyre gonna,kill me I probably ended up with liver,cancer but thank you for good blessings,that was day five for anybody I got,eight weeks of this total after four,weeks Ill have a video of me going to,the free clinic or not to the free,clinic to the hospital get blood work,done,and Ill vlog that as well anyway you,guys have a blessed day,[Music]

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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

RxOutreach: Making medications affordable (April 2021)

[Music],[Applause],hello everyone and thanks so much for,joining the needymed special topic,webinar,rx outreach making medications,affordable,my name is carla im the director of,user engagement in needymeds and before,we get started,im just going to offer a few tips so,you can make the most out of the,presentation first of all,if you do have questions you can type,them in anytime,into that questions section of your go,to webinar control panel,just know we will reserve answering,questions until the end,if we dont have the time to answer your,question we will follow up with you,by email but of course we will provide,the contact,information for both needymeds and rx,outreach at the end,this webinar is being recorded and will,be available on the needymeds youtube,channel,and you can find copies of our,powerpoint presentations,as well as other materials we thought,youd be interested in in that handout,section,of your go to webinar control panel,so lets get started with what is,needymeds,now as you can see on your screen now,there is our fancy wording about our,mission statement and a statement about,how we achieve our mission,but simply put needymeds connects people,to programs,that will help them afford their,healthcare expenses,and we do that free and anonymously,through our website,needymeds.org and our helpline,oops sorry about that and that help line,is 1-800-503-6897,we are on the east coast so we are open,9 a.m to 5 p.m weekdays eastern time and,we do have spanish speaking counselors,as well,on your screen now is just a screenshot,sorry it looks a little blurry but i,apologize for that but this is a,screenshot of needymeds.org and i always,like to put,a snapshot of our website up because it,gives me an opportunity first of all to,show you what it is,and second of all to point out some,resources i think youd be,most interested in for example if you,are looking for,health care savings resources youll,find those under the healthcare,savings tab also i mentioned that this,webinar is,being recorded and will be available on,our youtube channel and you can find a,link to that on the top right,of our home page with the rest of those,social media icons i think its the,third one from the left,and we hope you subscribe that way,youll be notified when new,presentations webinars,or videos are added and you wont miss,out on anything you may be interested in,you can view or register for other,upcoming webinars on the calendar events,on the bottom right hand of our home,page,so now as you saw in our mission,statement an important part of what we,do is,educate people and of course we do that,by letting them know,about needymeds but also by letting them,know other ways to save on or afford,their health care expenses,which is why we are so pleased to have,our guest bill vadarat from rx,outreach here with us today and before i,introduce bill let me tell you just a,little bit about rx outreach,its actually the nations largest,non-profit,fully licensed mail order pharmacy,it offers more than a thousand,medication strengths,at affordable prices mission to provide,affordable medication to the underserved,rx outreach partners with hundreds of,clinics and,organizations across the country to,provide,a crucial health safety net for those,who battle both illness,and poverty since 2010,rx outreach has served over 420,000 people and helped them save more,than,822 million dollars,on their prescription medications,compared to retail costs,now i will be honest with you i was um,in preparing for todays presentation,i asked my friend and colleague bill,whos the presenter today,to provide me with some updated stats,for rx outreach and i really was blown,away by those numbers,that since just 2010,that theyve served over 420 000 people,and help them save more than,822 million dollars,on prescription meds compared to retail,costs,i was just blown away by how much,theyve been able to accomplish and i,needed to stress,that so now let me move on to tell you a,bit about our guest,um bill vadarot is the marketing manager,at rx outreach,but as ive said in other presentations,that title really doesnt quite cover,the extent of what he does,nor his passion for helping people bill,has worked in non-profits,for over 25 years including the last,five and a half years,at rx outreach he graduated from,catholic university in washington dc,and later earned a masters degree in,theology and,in divinity from the kendrick school of,theology,he also recently completed his doctoral,work,and passed the comps in educational,leadership,at st louis university i think both his,professional and academic experience,speak to his dedication to helping,people,and making a difference in their lives,so were so proud and pleased to have,his partnership,and are grateful that hes taking the,time to share his expertise with the,needymeds audience,so without further ado im going to go,ahead and pass the mic,and the screen to bill now as we do that,and he grabs the screen,i will remind all of you that again if,you do have,questions during bills presentation,you can go ahead and type them into that,question section of your go to webinar,control panel,and bill if you go ahead to the top left,hand side where it says display,settings i think that will give us a,larger view,and remember if we dont get the chance,to thank you bill and if we dont get,the chance to,answer your question we will provide our,contact information at the end and we,encourage you,to reach out to either rx outreach or,needymeds,so without that i will pass the mic and,screen to bill which is why you are all,here today,to learn about rx outreach thanks,everybody and enjoy the presentation,thanks carla um carla can you just see,my powerpoint or is the go to webinar on,the screen as well nope i see just your,powerpoint,as large as it can be were good to go,thanks for checking bill all right,thanks carla hey good afternoon,everybody i appreciate you being here,uh my echo uh carlas welcome,uh that this is uh an important topic,all of us are here for different reasons,um whether youre a patient yourself,whether youre an,advocate uh whether you represent um,a clinic a doctors office uh or even if,youre,uh just here to uh find out,about a person in your family that needs,medication and you want to find another,resource,we welcome you um this is um this is why,were here,to reach out and and help folks learn,about rx outreach,uh i i i wanna first of all just let you,know that um,im not gonna tr cover everything this,is kind of a high level,overview of rx outreach but i wanna make,sure that everyones questions are,answered so as carlos said please use,the chat,um everyone has pretty much the same,questions about rx outreach and the,first,is whether its real um yes,were real were legitimate we exist um,why havent you ever heard of us,well um im not sure but hopefully today,will be,a day that you can come away with lots,of answers so um rx outreach is as carla,said is,is a countrys largest non-profit mail,order pharmacy,today were going to give you an,overview um,discuss our our mission the how and why,some special programs and a partnership,one thing that is is important to know,is that rx outreach,we do uh we are mission focused so,most importantly um we are a non-profit,that exists to help people get the,medication they need,so we want to improve the health,outcomes for,patients for thats why we we try to be,patient focused,transparent convenient and,sustainable were not here to replace,your local pharmacy um were here to,to complement what others in in the,healthcare,field are doing so our mission uh is to,provide affordable medication to people,in need,and that is pure and simple so,everything we do is guided around that,when i actually started at rx outreach,uh,five years ago i started in the,fundraising and development department,um and i asked i said why dont we just,add a dollar to each prescription,and then we wouldnt have to do any,fundraising,and i was quickly

Accessing HCV Medication Through Insurance

hello everyone my name is Michelle,Martin and Im a clinical pharmacist at,the University of Illinois at Chicago I,work at the University of Illinois,Hospital and Health Sciences system,liver clinic I have been working with,hepatitis C patients since 2009 so Im,excited to talk to you today about the,challenge of obtaining hepatitis C virus,medication approval my objectives for,today are to discuss how to tie to C,virus treatment goals and costs as well,as review some sample Medicaid and,Medicaid managed care requirements for,hepatitis C virus medication coverage,and also will list some patient,assistance programs that can assist you,first I wanted to do a little bit of,background on hepatitis C virus just to,bring everyone up to speed,hepatitis C virus is the most common,blood-borne infection in the United,States,its nearly four to five times as,prevalent as HIV is and hepatitis C,virus is leading known cause for liver,transplantation its also the main cause,of liver related death and stage liver,disease as well as hepatocellular,carcinoma there are many different,hepatitis C virus genotypes actually six,of them that have treatment,recommendations and there are many,different subtypes denoted by small,letter A B etc theres actually no,current vaccine available they are,certainly working on this but we dont,have a vaccine for hepatitis C virus at,this point in time but we do have,effective treatment as you can see by,the table here we have many patients in,the world that are affected by hepatitis,C virus its estimated that about 177,million people have hepatitis C virus,worldwide and the global death rate is,estimated at nearly 400,000 people per,year in the United States its estimated,that we have between two and a half and,four point seven million patients with,hepatitis C virus and of course the,death rate the United States is actually,climbing so we have nearly 20,000,patients that die each year from,hepatitis C so its our goal to treat,more people to help cure their hepatitis,C,prevent these morbidity and mortality z,that we see with hepatitis C virus so,what is the goal of our hepatitis C,virus treatment we want to achieve a,cure a cure is denoted by a sustained,viral logic response or SVR and this SVR,means that no virus was detected in the,blood at 12 weeks after the completion,of hepatitis C virus treatment so its,important to get your blood checked,during treatment and at the end of,treatment as well as 12 weeks after,treatment to maintain that we have a,cure just to highlight that the goal for,hepatitis C virus is shared by providers,patients and insurers,we all want to make sure that we cure,the patients who are treated for,hepatitis C virus so lets talk a little,bit about the progression of hepatitis C,virus here we note that on the bottom of,the screen we have the approximate time,in years although this progression of,hepatitis E virus differs among patients,and the time of their infection and,other cofactors so starting off with,acute infection some patients will,display symptoms or signs of acute,infection including jaundice malaise,some nausea and just general symptoms,that may be dismissed about one in six,to one and four people actually can,spontaneously clear the virus and not,develop chronic hepatitis C virus,however the majority of people actually,do go on to develop chronic infection,they can then go on to develop mild,moderate or severe hepatitis and of,those patients about one in five will go,on to develop cirrhosis or the most,advanced scarring of liver from there,some of those patients will decompensate,being that their liver will no longer be,able to do its job well and from there,we move on to end-stage liver disease,and the need for transplantation other,patients with cirrhosis will go on to,develop hepatocellular carcinoma so,thats why its so important that we,treat hepatitis C virus ideally before,patients develop cirrhosis that we can,prevent these other things from,occurring we also want to make sure that,were screening our patients with,advanced fibrosis and cirrhosis,to make sure that theyre not developing,hepatocellular carcinoma so now well,move into the hepatitis C virus,treatment evolution on the y-axis along,the left hand side you can see the cure,rate or the SVR rate thats associated,with specific regimens for hepatitis C,treatment along the x-axis or the bottom,you can see the different treatment,regimens and when they were first used,and then you can see what their level of,cure or cure rate was you can see that,back in the 1990s that the cure rate was,very low with treatment treatment had a,lot of side effects and a lot of,patients did not enjoy the course of,treatment because it was much more,difficult with a lot of side effects,that they this slide goes over the,hepatitis C virus treatment evolution on,the y-axis you can see the SVR H or the,cure rate along the x axis at the bottom,you can see the different medications,and when they were approved for use for,hepatitis C virus treatment you can see,since the 1990s the cure rates has,improved drastically for the medications,that we had in 2011 we had our first,direct-acting antiviral agents approved,that were added on to treatment with,pegylated interferon and ribavirin these,earlier treatments for hepatitis C virus,had a lot of side effects in patients,health usually a lot of complaints,during the course of treatment starting,in 2013 we had the approval of all oral,treatment for hepatitis C virus so as,you can see weve had several different,medications approved and now we have,eight different regimens for patients,who have genotype one so there are a lot,of different options as far as the,medications that we can use and as you,can see by the SVR rates these agents,are highly effective so patients enjoy,fewer side-effects and most patients,achieve a cure the problem of course is,how do we pay for that cure so there are,a few different ways that we could pay,for hepatitis C virus treatment of,course the first would be paying cash,for the treatment I have had very few,patients that have actually been able to,do this due to the high cost of,treatment,the most common way to pay for hepatitis,C virus is through insurance and,certainly we do have some patient,assistance programs that can help either,with co-payments or to cover the entire,cost of the medications in some specific,instances so this slide just goes over,the wholesale acquisition cost or the,advertised price of the medications for,hepatitis C virus I bet youre all,thinking wow these medications are super,expensive and it is true,thats why hepatitis C virus treatment,has been such a challenge for most,people to get medication approved,through their insurances so you can see,on the top listing on the left-hand side,we see all the different medications,that are available and you can see on,the in the middle column we have the,cost for eight weeks because because we,have two Frenchmans that are actually,available for eight week treatment arms,in the middle column we have the cost,for twelve weeks and most agents are,able to be used for twelve weeks its,much less common now that we would need,to treat a patient for 24 weeks as you,can see those medications and regimens,are much more expensive when theyre,doubled or tripled in length for cost so,how do we weigh these costs of course,the costs of genotype one treatment can,be as little as twenty six thousand four,hundred dollars as that wholesale,acquisition cost up to ninety four,thousand five hundred dollars for the,wholesale acquisition cost of a,combination regimen versus the costs of,a liver transplantation if a patient is,unable to get treatment and then has,progression of their liver disease such,so that they would actually decompensate,and need a liver transplantation the,cost is extremely high so it makes sense,to treat people early so that they dont,decompensate and need a liver transplant,I think its important to go over that,insurance basics fo

Treatment of Hepatitis C 2017: Easy to Treat, Easy to Cure!

actually for our last discussion I left,of course the liberal group they asked,us to put the put it in mock format,eventually thats the way youre gonna,get CME credit now and also,recertification credit so if you collect,enough of these but you have but we have,to do the questions exactly right,actually so we have to have questions,answers and then a little sentence or,two to explain what were doing so,thats why you see these questions here,along along the way so Im sure you guys,are aware this actually New York State,law since October 2013 requires Hep C,screening offered to every individual,born between 1945 who gets admitted to,the inpatient hospital actually or who,sees their primary care doctor or who,sees their primary care overdue I am,its not its not mandatory adjust the,offer is mandatory so weve been getting,some numbers in over an ima we started,really slow we actually looked at how,many you know before we intervened and,then there was an educational component,well before we intervened it was,virtually zero and then it was an,educational component and then it got to,like 0.1% shows you have good,educational components are and then and,then there was a flag those wonderful,yellow flags on epic it got to 20% and,then we did the combination education,and yellow flag and it got to 20.1% us,so now they have now actually theres a,little competition going on now,everybodys getting starting to see,whos doing better than that in terms of,physicians are pretty competitive so,actually with all the other,interventions now were up to close to,eighty nine percent actually screening,baby boomers,the probably should be screaming,everybody else and actually this is,something thats in all of our package,inserts now for da a drugs when were,treating Pepsis have bu reactivation,so you might see this in the hospital,actually its not as important if,somebodys just getting started on,treatment mostly just to make it simple,these are 29 cases mostly from Japan and,mostly because they hadnt been,screening effective leaves for FBI speak,so part of Hep C treatment you have to,screen for a and B and vaccinate for a,and vaccinate for me if theyre not,eligible but the screening for B is s,antigen antibody at core so you have to,have all three so basically what,happened here in most of these Japanese,patients they only did was scream for s,antibody it was negative they gave me,the vaccine they didnt check for s,handed so basically the hepatocyte is on,capable of making one virus efficiently,at a time so if youve got five million,IUs of hepatitis C and youve got five,hundred I use and hepatitis B when you,kill off the hepatitis C you have times,B has the hold of a decide to itself,and it takes off actually who caused a,flare liver failure etc etc and thats,kind of what happened so they werent,act they werent really looking so if,youve got both B and C on board you,need to put them on a B medication,before you have C so you see a Big B,flare fulminant a flare because Pepsi,yeah although frankly amongst our,colleagues that I you know in our,Institute weve treated over 6,000,patients we have not heard one actually,so maybe weve gotten them to stream,directly anyway so alright so heres,another thing to think about so heres,heres the case Christine 28-year old,Caucasian woman working for an,accounting firm on our way to earning,yay shes been using IV heroin for about,14 years,she this is not Im not making this up,she started at the mall in New Jersey,when she was 14 with her high school,friends,shes been every had three times but his,f3 relapses comes to her GYN for a late,period afraid she might be pregnant,astrid GOI on to test her for everything,everything to a medical doctor and,everything to a GYN are probably,different everything,anyway so once you the GYN test for FP,HIV Amelia,Pepsi syphilis yeah all right this is,this is a softball you get you warmed up,here its all of the above,obviously heavy is the law for all,pregnant women HIV is standard and Craig,is reinforced and for PW pee pee pee,woods people who object drugs thats,what thats thats the politically,correct its actually also cant say,unsafe sex anymore,you have to say condomless sex I learned,so its not unsafe its just condomless,and this is people who jet trucks to,take stuff it takes the abuse chlamydia,standard Hep C is really not tested,actually in pregnant most younguns,dont even know about it,and then syphilis of course so clearly,she should be tested occasionally I get,referrals from you I am where its not,quite the same story but its like you,know its a one-night stand and she was,really drunk and then you know who the,guy was and and then its like has to go,to the GYN during the next week and says,doc test me for everything because I,dont know you know where this guy was,coming from and the GYN throws in a Hep,C fest actually and we get a false,positive antibody Ive never seen that,give real positive anyway so shes this,shes courting Im sorry is it not this,supposed to be negative thats a typo,so shes core antibody positive HIV is,negative committee is positive that she,was treated Hep C antibody is positive,reflexes to PCR positive you all know,now that every Hannah but there are no,antibody tests for Hep C anymore in the,institution the entire institution,actually does not do antibody tests for,epsy they do antibody reflexing to pcr,so i took us about two years to get that,to happen because the lab draws two,tubes now and the order have two,antibody tests over the antibody test is,positive,theyll reflex it through the PCR so you,dont have to call the patient back yet,so its a one step process syphilis was,negative and the pregnancy test was,negative,okay so next step should be all except,one,AFP Hep C quant Evanson phenotype kept a,IgM a domino of the sound birth control,pills so this also makes me crazy,actually it gives everybody checks off,the hepatitis panel which is actually,kept ekkada this panel and it has Hep A,IgM and have the core idea both of which,are useless tests unless its an obvious,you know acute hepatitis because we,dont care about that this is the one we,care about actually and then of course,the B and if if shes negative then we,need to back today okay so are you,surprised in a young woman or not a baby,boomer would be coming in with hepatitis,C yeah I thought the epidemic was over,no Pete woods are all over the place yes,she has jobs no aware of the new,epidemic can jump people guess he,werent,okay now the epidemic in 30 year in,under 30 its about the same size as the,baby actually first the CDC from may do,Hep C infections nearly tripled in the,US over the last five years people kept,saying to me in 20,fifteen okay youre gonna retire now I,have seen cured right its all over,nothing left to do well guess what we,actually havent taken more out of the,pool and have come into the pool since,2015 so its huge,this is hepatitis C infection among,reproductive age women and children in,the u.s. 20 2006 to 2014,this is the age 15 v 44 look at that,shape of that curve yeah I just its,going north and at a pretty much,exponential rate and then this actually,increased Hep C virus detection and,limit of childbearing age and vertical,transmission in the US and Kentucky here,actually and look at this actual if,Kentucky children also not quite,exponential but huge huge,its a massive issue all this is due to,the IV opioid use its all over the,Northeast its all out there in the,mid-atlantic states paternal fetal,transmission is booming we actually one,of the other our other new liver higher,I should have brought her along today,too is Tatyana Kushner who some of you,may remember as a resident Tatyana wants,to do womans liver disease and shes,writing a protocol for this shes done a,lot of pregnancy transmission of,hepatitis B maternal feel mother to,child MCT transmission of epi worked,before and were gonna add Hep C to that,now because this is big push to start,treating Hep C in pregnant women

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