1. High cost of Hep C drug a barrier to treatment
  2. Measuring Costs For Hepatitis C Treatment
  3. Hepatitis C Treatment Update
  4. How to treat hepatitis C
  5. Affording Hepatitis C Treatment
  6. How a buyers club provided affordable hepatitis c medicine
  7. With highest hepatitis C mortality rate in U.S., Oregon expands access to life-saving drugs

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

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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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

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How to treat hepatitis C

[Music],you had a blood test called a hepatitis,C antibody test and the test has come,back positive this means the tests found,hepatitis C antibodies in your blood at,some point youve come in contact with,the hepatitis C virus hepatitis C is a,virus that lives in the blood and can,have serious effects on your liver even,causing cancer around one-quarter of,people clear the hepatitis C virus on,their own unfortunately even if they do,fight it off naturally they can get it,again if they put themselves at risk,there is no immunity to hepatitis C and,no guarantee of being able to clear it a,second time your doctor or health worker,will have to do another test to see if,you have the hepatitis C virus this is,called a PCR RNA test if this test is,positive it means that you have the,hepatitis C virus and without treatment,it will be there for life they will also,discuss with you about when you think,you may have contracted the virus so,what will happen to me most people,living with hepatitis C dont feel sick,for a long time but slowly over many,years they make it tide run down and,unwell this can make life a lot harder,to live and sometimes is very serious,even deadly the good news is there is,now a very effective cure that you can,get from your doctor there are new,treatments to cure hepatitis C and,around 95% of people on treatment will,be cured just be aware even if you clear,it or its cured you can still catch it,again,what is the treatment for most people,all it takes is one pill a day for eight,to 12 weeks and a few simple blood tests,along the way its very important that,you take your treatment every day until,you complete the course,unlike previous treatments they are very,few side effects during treatment your,doctor or healthcare worker will do a,blood test to see how youre going and,if it seems to be working after 8 to 12,weeks youll have finished your,medication and youll have another test,which we hope will confirm your,hepatitis C is gone the doctor will want,to see you again,a few months after taking your last,tablet there will be another test called,an SVR test this is the most important,blood test as this is the one that tells,us if youre cured but remember this is,a cure,not a vaccination so you can get,hepatitis C again if you put yourself at,risk if you become reinfected that does,not exclude you from further treatment,how do you get hepatitis C,hepatitis C is only passed on through,blood to blood contact most everyday,activities do not pass blood from one,person to another,just living working and being around,people who have it is not a risk,the most common way of passing on blood,is by sharing any equipment used for,injecting drugs and you can get it from,using unsterilized tattoo and body,piercing equipment for sharing razors,and toothbrushes and ceremonial tools so,basically anything that passes infected,blood from one person into another how,do I stay healthy to make sure that,youre cured you must take the pills,every day for the time your doctor says,and have your blood tested when its,needed stay in contact with your doctor,or healthcare worker theyre here to,help you follow the treatment and answer,any questions dont share anything that,can pass infected blood from one person,to another and we all feel better when,we eat well exercise and cut down on the,grog your liver will thank you for you,can always call the people at hepatitis,WEA on these numbers and remember,theres always care and support for you,when you need it

Affording Hepatitis C Treatment

good morning welcome to our,webinar,title of our webinar this morning is,financial literacy,affording hepatitis c treatment my name,is ken oriordan,and im talking on behalf of the,american liberal foundation,as you know hepatitis c affects between,3.2 and 5.2 million people in the united,states,at 80 percent of these patients go on to,develop chronic infection from this,20 of these patients will develop,complications from hepatitis c such as,cirrhosis,liver cancer often requiring intensive,medical therapies medications,hospitalization and possibly liver,transplantation,fifteen thousand people,die annually from hepatitis c infection,in the united states,the world health organization has,talked about a global call for the,elimination of hepatitis c,their vision is a world where viral,hepatitis transmission is stopped and,everyone has access to safe,affordable and effective treatment and,care,there are 20 20 targets that 3 million,patients with hepatitis c will have been,treated,this is feasible by scaling up six key,interventions to high coverage,hepatitis b vaccination including,vaccination at birth,safe injection practices and the use of,safe blood products,harm reduction for people who inject,drugs,safer sex including condom promotion,treatment of hepatitis b and cure of,hepatitis c,their 20 30 targets are that 90 percent,of patients with hepatitis c will be,diagnosed,80 percent will be treated and there,will be a 65 reduction in mortality from,hepatitis c,when we look at the burden of advanced,liver disease over the next couple of,decades,well see that liver disease from,hepatitis c was much more prominent,in over the last 20 or 30 years with,increased frequency and severity and,certainly the risk of developing,cirrhosis from 1990 when,there was a risk of five percent chance,of cirrhosis this has been projected in,year 2020,that 37 of patients with hepatitis c,infection will have evidence of,underlying cirrhosis,certainly treating hepatitis c has been,shown to reduce healthcare costs in the,united states,well see here in this graph that the,difference between treated and untreated,patients,both with non-serotic liver disease,compensated cirrhosis as well as,end-stage liver disease,treatment definitely,is beneficial in reducing both total,costs of healthcare,medical costs in general and also costs,related to hepatitis c infection,when patients eradicate the virus or,cured hepatitis c the sustained,biological response rate has been,associated with various different,improved qualities of life,this is a study from a real world clinic,population,where treatment and eradication of the,virus was associated with improvement in,bodily pain improvement in general,health physical functioning as well as,emotional and social functioning there,was also an improvement in mental,summary scores and physical summary,scores with eradication of the virus,certainly treating hepatitis c may have,multiple other benefits,hepatitis c cure definitely reduces the,incidence of type 2 diabetes mellitus,treating patients with hepatitis c,who also have diabetes mellitus,does decrease their frequency of,development of end-stage real,insufficiency as shown in this graph on,the right there is also improved renal,and cardiovascular outcomes,with hepatitis c what happens if we do,nothing well a couple of studies both,from england as well as sweden have,shown that,over the next 20 years there will be a,significant increase in the development,of decompensated cirrhosis,hepatocellular carcinoma as well as the,need for liver transplantation,treatment of hepatitis c can be done at,various different,points in the disease course,treating patients early in the disease,course can help prevent progression of,liver disease in this study progression,was seen,from patients,with mild liver disease initially to,more advanced liver disease in 15,of patients over a period of 20 years,treatment did decrease this,progression of liver disease,if we treat patients with cirrhosis,there is certainly a rapid reduction in,mortality,but we are forever playing catch up with,the disease people with cirrhosis still,remain at high risk of hepatocellular,carcinoma and must remain under,surveillance for this,these patients however are the most,expensive to treat,so how do you motivate testing without,offering potentials for patients to,undergo therapy,so who should be treated for hepatitis c,infection well the short answer is,everybody,the recommendations from the american,association for the study of liver,disease and the infectious disease,society of america,are the panel continues to recommend,treatment for all patients with chronic,hepatitis c virus infection,except those with short life,expectancies who cannot be remediated by,treating hepatitis c by transplantation,or by other direct therapy,when we look in the united states at,gaps in hepatitis c treatment and,evaluation,we notice on this graph here that of the,patients who are initially diagnosed as,being hepatitis c antibody positive,only a small percentage of those,patients subsequently undergo testing to,confirm active viremia,an even smaller number undergo therapy,for hepatitis c,however once patients undergo therapy,for hepatitis c with the newer therapies,most patients are able to complete,therapy and a high percentage of,patients,achieve a sustained biological response,all persons with current active,hepatitis c affection should be linked,to a practitioner who is prepared to,provide comprehensive management,improvement in the identification of,hepatitis c infection and advances in,treatment will have limited impact on,hepatitis c morbidity or mortality,without content improvement in linkage,to care this is extremely important,certainly care of patients with,hepatitis c is extremely complication,involves multiple different people in,the healthcare environment there,typically is a provider for hepatitis c,with you may be an rn a,nurse practitioner or physician,theres usually administrative,coordinator in the office a pharmacist,who is involved in coordination care for,medications,a case manager,somebody who was involved in assessing,fibrosis which could be a laboratory,technician or a technician involved in a,fiber scan measurement or an mr,eye of the liver to assess fibrosis,frequently these patients do have,a mental health provider involved in,their care and often addiction,specialists are involved in patients who,continue to use intravenous drugs,with decompensated liver disease,patients are frequently referred to a,hepatologist or liver transplant center,so what are the benefits of achieve your,sustained biological response well the,goal of hepatitis c treatment is a cure,of hepatitis c,this is associated with improved,clinical outcomes which can either be,hepatic such as a decrease in the,incidence of cirrhosis,liver decompensation,decreased incidence of hepatocellular,carcinoma and decreased need for liver,transplantation,there also is an improved quality of,life a decrease in frequency of,malignancy diabetes,coronary disease renal disease as well,as improvement in neurocognitive,disorders,but also curing hepatitis c most,importantly does result in decreased,transmission of the infection,the therapies we have for hepatitis c,have evolved significantly over the last,20 years,back in the 1990s we were treating,patients with standard interferon,therapy with its various different,side effects and this was very difficult,for patients to take and typically,10 to 15 percent of patients eradicated,the virus with that treatment,during the 19 late 1990s and mid 2000s,the addition of other,regulated or long-acting interferons,improved their sustained biological,response rate and over the last five,years the,treatment for hepatitis c has exploded,rapidly with the addition of oral,medications,which initially have been given with,interferon with sustained biological,response rates of 70 percent and most,recently the combination of all oral,antiviral therapie

How a buyers club provided affordable hepatitis c medicine

[Music],[Music],when I first started peoples contacted,me from all over the world it was a,pretty steep learning curve like how to,organize this it just sort of kept on,getting bigger and bigger until I was,like getting 200 emails a day,I might get a find rested jail,if I dont do what Im doing,people will die its straight from the,script of Hollywood movie Dallas buyers,club an Australian man in his 60s is,taking on the global pharmaceutical,company,Greg Jeffries has supplied more than 100,Australians who have hepatitis C with,life-saving drugs from India because he,says the Australian medical system has,failed them his land at the House and,Princess Street Ive always been very,healthy you know like as I said even in,my drug years I you know I surfed a lot,I was outdoors Ive really not had any,health issues until sort of when I hit,my 50s,then I started to get these mysterious,things going wrong with my health which,now the doctors can figure out and,suddenly my health just went back,something I started getting nosebleeds a,reason my gums started bleeding if I,scratched myself I would bleed and very,quickly the doctor did the tests and I,discovered I had hepatitis C it took a,lot of talking to specialists to the,hepatitis nurse at the hospital to,figure out that actually Id got it back,when I was 20 or using intravenous drugs,it was good to know how I got it and,then of course the next big question is,how you get rid of it,a new drug is curing hepatitis in just,weeks it is being called the best drug,launch in history a miracle drug it,actually cured habitated thief I did,research and and you soon discover that,wow theres a really good cure available,really effective really safe and then of,course I found out that it was more than,a hundred thousand dollars Australian to,buy it which is the price of a house,here this new treatment would just been,released in the USA everyone was talking,about it then mostly people were talking,about the fact that it was so expensive,[Music],expensive and you soon discover that the,pill look you have to pay a thousand,dollars per pill for actually cost less,than fifty cents to make and its at,that point we start to say well theres,something wrong with the whole system,they dont care if people die because,they cant afford the drug,I just want top dollar,what keep trying guys what are you doing,guys youre needing Hep C treatment huh,to over two years but in Sweden they,have only get the medicine for the,people thats you know really really,really see I can ship direct to to you,in Sweden say you would have the,treatment in basically two weeks its,amazing okay,so Laura was good looking I think,theres a more thorough,to have hep-c you know your blood is,infected can affect other people in your,life like my daughter like my wife Im,afraid of my shaving stuff,[Music],I dont want my daughter to get my,toothbrush is feel like youre bloody,and hurt people I know I got my Hep C of,dirty needles sharing with other people,you know I didnt care about anything,you know I know the risk about sharing,needles but I didnt care I just care,about the next fix the Hep C is the last,thing for me to deal with to feel normal,in that way you know Ive fought the,addiction I fought a lot of problems in,my life you know but the Hep C is still,there and dragging me backwards you know,[Music],generality kappa god Ive seen what how,sick you can get if you live with the,hepatitis E for too long my father has,had it for a long time and he was like,you know walking dead autumn approaches,authoritative restrain ro volsung know,there are may americana some seed upon,medicine M asam ticular many who live in,the river tamping you know I mean I,think that Thomas I am pistol we know or,else along with some medicine,I just starting look up on the internet,all stored my father about this and he,felt as Ive seen on the internet you,can buy some medicine from overseas,I read all the stories and every stories,everybodys talking about great great,great and he told me that he can fix the,transportation from India,thats what too good to be true,[Music],when you do the research you discover,that India makes a huge amount of,pharmaceuticals that get sent all over,the world as generics you know,[Music],I started to find people in India who,could ship from India to different parts,of workers theyd been doing that with,generic HIV drugs amongst them I got an,email from Parag who was you know a,licensed exporter of pharmaceuticals and,often to help in any way could the,sources are very reliable and they said,that a brand is going to be important,since all we had to figure out what the,rules were in all the different,countries for forgetting generics into,peoples place Serbia we just the first,shipment we just sent there it got,seized basically were doing a,country-by-country assessment we would,use third-party volunteers in other,countries where the rules were better we,just figured out ways of getting around,every blockage that we can so nowadays I,can guarantee delivery to absolutely,every country on this,hey hey how are you the present for the,patient the patients so me and our were,introduced by Greg about a year ago our,was probably you know looking to source,the Indian licensed generics a big,reason for us to collaborate with a lot,of these BIOS clubs which might have not,of illegality in their way of operations,but definitely on a ranking of morale,they have a much more higher ranking as,compared to a big pharmaceutical company,[Music],[Laughter],[Music],I come in India and I take the meds from,here the generics I give to the patient,the treatment the treatment is very well,I choose the doctor dont show my face,because I protect me and my family it is,very risky for because of the custom you,know how you pass with the treatment if,they stop me I tell is for me and my,family,[Music],[Applause],Im very relieved Im very happy,nothings happened and I passed the,border the custom and everything and all,is okey in our country we have a lot of,poor people who dont have money for,treatment who wait at the doctor for the,on prescription something some people,receive it but in the last moment in the,high three positions its already too,late about million people every year,going through this theres about a,million new infections every year one of,the very early things that I had to deal,with was the fact that in a lot of,countries what I was doing was illegal,arms smuggling drugs,and that caused me some concern but the,reality is a high portion of the people,who I get medication too will die if,they dont have the medication so,ethically morally I have no problem is,breaking the law in countries where it,is illegal to do what Im doing I became,aware that that I was treading on the,toes of Big Pharma,very early in the piece I got a letter,from Gilead and it was a,cease-and-desist official legal little,suddenly I couldnt access my my blog,website anymore that password had been,changed I said well could you tell me,what the complaint was about no is there,anything I can do to fix it up nope,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 its time to,talk to Gilead the manufacturer of,sovaldi it is an outrage that you have a,company whose profits have soared in the,last few years their revenues have,doubled I believe in the last year,theyve come up with the drug they are,charging the general public a thousand,dollars a pill for that drug,the original price was were about the,same as the therapies that were,currently available the therapies that,are available five years ago had about a,five to ten percent cure rate and were,quite toxic we saw that the new regimens,avowedly being one of them as being more,effective much more effective eighteen,ninety ninety five percent a much safer,so we thought pricing at around about,

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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