- High cost of Hep C drug a barrier to treatment
- New Antivirals for Hep C in Context of HIV: Vosevi and Mavyret
- Hepatitis C & Cirrhosis // symptoms, diagnosis & treatment
- RxOutreach: Making medications affordable (April 2021)
- Mavyret (glecaprevir/pibrentasvir) | Tita TV
- Mavyret Treatment Update | Does Mavyret Really Work?!?!?!
- Accessing HCV Medication Through Insurance
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
New Antivirals for Hep C in Context of HIV: Vosevi and Mavyret
my name is Brian wood medical director,for the Mountain West a e.t.c echo,welcome to this weeks session and I,will turn it over to todays speaker so,well dive right in,so first of all I want to let you know,that in addition that these drugs being,approved but there there are new revised,aslv IDSA guidelines those were updated,in late September and they do cover,these new medications and also some some,new information on antiviral resistance,as well as HIV so this is what was kind,of cold from those those paragraphs and,and when they talk about Vasa V which is,so fast Bevere develop at a sphere and,voxel a Prevert I think its really,important for this crowd to know that it,was not actually formally studied so,were really extrapolating from the HIV,negative population and weve really,seen that thats not much of an issue in,terms of efficacy its a little bit more,of an issue from from drug drug,interactions now collect appropriate pin,branches fear or maverick has been,formally studied in a nice phase 3 study,of almost hundred forty patients and it,did have a variety of patients and had a,good SVR so my aunt take on these two,drugs is that Im really reserving,softlocks or Vasavi for Salvage regimens,the people who have failed our,second-generation das whereas Im using,GP or maverick more as an initial,treatment it is indicated for,retreatment but that just kind of give,you my take on those two two medications,and how I view them so lets dive into,whats now approved by the FDA is,getting a longer and longer list so many,of you know about harvoni just remind,folks its not pan genotypic so you miss,your twos and threes by Kiera pack which,is the three drug regimen and in it and,includes ritonavir is made by advant I,really anticipate that thats not going,to be supported youre not going to see,that on formularies and youre not going,to see that used as much primarily,because the drug drug interactions and,hi pill burden and also you need to use,ribavirin maverick were going to talk,about and the key thing I really wanted,to draw your attention to here which was,a kind of a game changer is the cost,26,000,so it was at least half of what the next,cheapest drug was Zepa tear and thats,really made a profound impact on access,I know in Alaska that that was a key,decision for opening up who can be,treated in Alaska State so now I think,all frey closest levels are are open to,treatment there so were going to talk,about that the Claddagh sphere again I,dont think is gonna be used as much,because its you know I have an,additional cost and you dont really,have much of a Vantage over maverick or,soft fell and Zepa tier is a good drug,for instead renal disease but you do,need to do this additional testing so a,little bit more groundwork for you,epic loses PN genotypic and saw file box,will well talk about that primarily for,a salvage regimen so I dont know about,you guys you probably in HIV T&L over 30,medications but sometimes that feel like,gosh theres so many different medicines,and you know my brain starting to get a,little full here so maybe you guys are,less sympathetic than us simplistic,liver Docs lets talk about soft valve,ox so this drug is one pill so single,single talbott regimen but they cram,three antivirals in there and made by,gillian they know how to do this so two,of them you you probably are familiar,with the so phosphor vel panis fear,thats up clues ax and youve got a,polymerase inhibitor there plus a tennis,5a and never what they did is they added,a third drug a Proteus inhibitor called,voxel a Provera and its a potent,antiviral it gets all genotypes so you,basically now have one pill that gets,all six genotypes and so were gonna,talk about the polaris studies players,from one in four these were published in,New England Journal of Medicine this,summer,the Polaris one study was a pretty large,Lucido controlled randomized clinical,trial that was looking at saw fel Vox,and people whove already been treated,with NS 5a inhibitors and failed it was,a international study and they basically,included cirrhotic sand and non Syrah,–tx so it was a placebo controlled,trial pretty straightforward,12-week regimen or guinea placebo and it,was a two to one randomization so more,people got the investigational drug,versus placebo just to give you an idea,of what were the prior ns5 as that were,used I was mostly harvoni so most of,these were with tipis fear failures 51,percent and then the next most common in,US v a that was used was to colitis fear,and a little bit of the bike hero pack,and couple these other maybe,investigational drugs that didnt quite,make it to FDA approval so I wanted to,first talk about side effects and just,to let you know that theyre pretty,similar side effects maybe a little bit,more headache in the sava box Group,fatigue is about the same but the thing,that definitely is shaking out is more,diarrhea its anywhere from five to ten,percent more common than AB clues a– or,with placebo and we know this about,protease inhibitors Hep C protease,inhibitors that they can cause diarrhea,some of you may remember tilapia veer,and and we used to call it fire rhea,it was a really burning toxic diarrhea,its not that its just just the kind of,you know loose bowel movements kind of,irritating and you can treat it with no,new usual anti diarrheal but just just,so you know you want to counselor,patients they might have a little bit,more diarrhea than normal so lets a go,then to the SVR 12 and the overall SVR,for these patients was was ninety ninety,six percent and you see theres a little,bit of a trend maybe in our genes have,forced kind of small sample size here,where they had 91% cure but theyve,people who are one Bs twos not a whole,lot of fives and sixes but they all did,well and this is an intention-to-treat,analysis so about half those people who,were considered failure were either lost,to follow-up whether they would do their,consent and theres a very small,percentage of people who actually had,true viologic failure so next I wanted,to talk about the Polaris for study so,we talked about the NS 5-8 failures but,this one was looking at patients who had,a treatment with other regimens other,das but not NS 5 As so kind of the flip,side of what we just looked at so most,of these were so fast River failures a,couple where sim saw failures I think,the other category is probably by Kiera,pack Im sorry wouldnt be back here,about could be like tech needy and the,overall cure rate was a 97% it,outperforms so foster develop at asphere,or at clues a– and it particularly did,very well in one as and threes that was,where then the major separation between,these two drugs was and and those two,genotypes categories so lets talk about,drug drug interactions with bou savy and,ARV so just to start out with that voxel,app Revere is a substrate for the O ATP,and the peak like o protein the breast,cancer receptors and then sip 3a and sip,1a to c8 so the big thing to know is you,cannot use this with a designer of,Ratana beer if you were going to use,this with Taff at M try setting L,batagor and Kobe assist at the voxel app,Revere levels go up so you might see a,little more diarrhea you just need to,watch out for that plus if youve got a,patients maybe a cirrhotic or pre,cirrhotic the P I in Vasavi the voxel,lab revere king can cause worsening of,the liver function so you might want to,watch those people a little bit more,closely there is also a slight,interaction between two Norfolk to not,figure the t DF form of that and so you,just want to watch for renal toxicity,and also the de Rivera Ratana beer its,not an absolute contraindication like,Annas Anna very just want to cut maybe,to follow LTS every four weeks in those,situations you know like like what we,did with Sinatra Val Pattis beer you,want to follow the Kratt name phosphate,in you a if youre using to not Revere,to the TDF version but the ones that,were test that we have a little bit of,preliminary data on and look
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Hepatitis C & Cirrhosis // symptoms, diagnosis & treatment
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RxOutreach: Making medications affordable (April 2021)
Mavyret (glecaprevir/pibrentasvir) | Tita TV
FDA warning reactivation of hepatitis B,virus this drug has a boxed warning,this is the most serious warning from,the Food and Drug Administration FDA,alerts doctors and patients about drug,show more what is Navarrete,Navarrete is a brand-new,and drug thats used to treat chronic,hepatitis C virus HCV this virus infects,your liver and causes inflammation,Navarrete can be used by people with any,of the six types of HCV who either dont,have cirrhosis liver scarring or who,have compensated mild cirrhosis,Navarrete can also be used to treat HCV,type 1 in people who have been,previously treated but not cured with a,different type of medication,maverick is approved for use in adults,its also approved for you,children ages 12 years in older or those,weighing at least 45 kilograms about 99,pounds,maverick comes as a single tablet that,contains two antiviral medications Glick,a further 100 milligrams and prepend,asphere 40 milligrams its taken by,mouth once each day,effectiveness in clinical trials adults,with HCV types one two three four five,and six who had never been treated for,the virus were given maverick of these,people ninety-eight percent to 100,percent were cured after eight to 12,weeks of treatment,in these studies being cured meant that,peoples blood tests which were done,three months after treatment showed no,signs of HCV infection in their body,for more information on effectiveness,see the effectiveness section under,maverick for hepatitis C below,FDA approval maverick was approved by,the Food and Drug Administration FDA in,April 2017 to treat chronic hepatitis C,virus types one two three four five and,six in adults,in April 20 19 the FDA extended the,drugs approval to include its use in,children,proved for use in children ages 12 years,in older or those weighing at least 45,kilograms about 99 pounds,maverick generic maverick is available,only as a brand name medication,in generic form maverick contains two,active drug ingredients Glick a fervor,and the Prentice beer,maverick cost us with all medications,the cost of Maverick can vary to find,current prices from a barrette in your,area check out good Rx calm,maverick 21,100 milligrams / 40 milligrams packages,t4 13400 $74 good rx fair price the cost,you find on good RX comm is what you may,pay without insurance,the actual price youll pay depends on,your insurance plan your location and,the pharmacy you use,financial and insurance assistance if,you need financial support to pay for,maverick or if you need help,understanding your insurance coverage,help is available,a V the manufacturer of Navarrete offers,a program called maverick patient,support which may offer help to lower,your cost of the drug,for more information and to find out if,youre eligible for support,call eight seven seven six two eight,nine seven three eight or visit the,program website,maverick side-effects maverick can cause,mild or serious side effects,the following lists contain some of,key side-effects that may occur while,taking map rat these lists do not,include all possible side effects,for more information on the possible,side effects of Navarrete talk with your,doctor or pharmacist they can give you,tips on how to deal with any side,effects that may be bothersome,more common side-effects the more common,side effects of Maverick can include,headache feeling tired nausea diarrhea,elevated bilirubin level a lab test that,checks your liver function most of these,side effects may go away within a few,days or a couple of weeks,if theyre more severe or dont go away,talk with your doctor or pharmacist,serious side-effects serious,side-effects from Everett are common but,they can occur,call your doctor right away if you have,serious side effects,call 911 symptoms feel life-threatening,or if you think youre having a medical,emergency serious side effects which are,discussed below in side effect details,include the following hepatitis B virus,reactivation a flare-up of the virus,if its already inside your body severe,allergic reaction mapper it has a box,warning from the FDA for hepatitis B,reactivation,a boxed warning is the,warning the FDA requires,it alerts doctors and patients about,drug effects that may be dangerous side,effect details you may wonder how often,certain side effects occur with this,drug or whether certain side effects,pertain to it,heres some detail,the side effects this drug may or may,not cause,allergic reaction is with most drugs,some people can have an allergic,reaction after taking map rat,its not known for sure how often people,taking this drug have an allergic,reaction,symptoms of a mild alert,action can include skin rash itching is,flushing warmth and redness in your skin,a more severe allergic reaction is rare,but possible,symptoms of a severe allergic reaction,can include swelling under your skin,typically in your eyelids lips hands or,feet swelling of your tongue mouth or,throat trouble breathing or speaking,call your doctor right away if you have,a severe allergic reaction to maverick,call 911 symptoms feel like threatening,or if you think youre having a medical,emergency,HM you may experience itching while,youre using map rat,in clinical trials some people have,itching while taking this drug bitching,most often occurred only in people,taking the drug who had both chronic,kidney disease in hepatitis C virus HCV,in this group about 17% of people,reported itching as a side effect,eating is also,times a symptom caused by HCV,bitching occurs in about 20% of people,with HCV this symptom is probably due to,a buildup of a chemical called bilirubin,in your body,eating caused by HCV maybe in one area,or it may be all over your body,if you have concerns about having a chi,skin while youre taking Navarrete talk,with your doctor,they can recommend ways to help reduce,the side effect while youre using the,drug,hepatitis B reactivation you may have an,increased risk of hepatitis B virus HBV,reactivation flare-up while youre,taking maverick,maverick treatment increases the risk of,HPV reactivation in people with both HPV,and HCV,in serious cases reactivation of HPV can,cause liver failure or even death,symptoms of HBP reactivation can include,pain in the right side of your belly,light colored stool feeling tired,yellowing of your skin are the whites of,your eyes before starting maverick,your doctor will test you for HPV,if you have HPV you may need to be,treated for it before you start taking,mavar at,or your doctor may recommend,testing during your maverick treatment,to monitor for HPV reactivation and,treat the condition if needed,weight changes not a side effect weight,loss and weight gain werent reported as,side effects of Maverick during clinical,trials,however maverick can cause nausea which,may lead to weight loss in some people,if you feel nauseous while taking this,drug youre likely to eat less food,which may result in weight loss,if you have concerns,weight gain or weight loss while youre,taking maverick talk with your doctor,they can help you plan a healthy diet,during your treatment,skin rash not a side effect skin rash,wasnt reported as a side effect of,Maverick during clinical trials however,HCV itself can sometimes cause a skin,rash,this may be mistaken for us,effect of the drug the rash caused by,HCV can be anywhere on your body,including your face chest or arms,it also might make,ability,if you have a skin rash while using,Navarrete talk with your doctor they can,suggest ways to reduce your symptoms and,recommend treatment if needed,side effects in children,in clinical studies side-effects seen in,children ages 12 to 17 taking maverick,were similar to side-effects seen in,adults taking the drug,in these studies no children stop,treatment because of side-effects,common side effects seen in children,included feeling tired nausea headache,elevated bilirubin level a lab test that,checks your liver function if youre,concerned about side-effects occurring,in a child using maverick talk with your,doctor the
Mavyret Treatment Update | Does Mavyret Really Work?!?!?!
whats up everybody this is light the,dark,were back again today with another,little video i wanted to uh,update a lot of people on my maverick,treatment because,its been about a year or so since i had,that treatment done,and i kind of just stopped with the,videos um i had like,i guess i had about 28 days worth of,videos on there,and a lot of people were like what,happened you know uh,did you finish the treatment this that,the other and at that time in our lives,we were going through a whole lot,of all our videos were done recorded on,on a cell phone basically,yeah i know how like it is yeah we were,we were struggling we were having to,live place to place and stuff like that,and i just kind of stopped making,videos basically i just kind of uh lost,steam on it i guess you would say,but i did want to update everybody on,what happened with that so,a little bit of backstory on it um as a,teenager and a little bit,early into my 20s i was an intravenous,drug user so i ended up getting,hepatitis c and hepatitis c is just a,disease that gives you a,liver cancer or you can get cirrhosis of,the liver really easily and stuff,and stuff like that luckily i didnt,have any type of damage like,that i just had the hepatitis c genotype,3.,well genotype 3 is treatable now luckily,um its fully basically curable,um as far as they know nobody whos been,treated by it has had any,type of it come back or anything like,that so far,but uh basically most people can be,cured of hepatitis c these days,with the treatment of maverick theres,other drugs for different genotypes,of hepatitis c and stuff like that um i,cant really think of all the names of,them right now but,for different genotypes of it theres,different drugs for different kinds and,it treatment varies based on how much,damage you,already have to your organs luckily i,didnt have very much damage or they,said no damage but im sure,and that was definitely a blessing,because you know most people would i,used a whole lot of drugs i mean i was a,big,big time drug user so its very,fortunate that i dont have,uh any type of damage yeah because that,was the deadliest one yeah yeah its,like the,the most deadly form of hepatitis c it,usually acts really fast the fastest,acting kind,yeah because hepatitis c is known to you,know drag on for 20 years,and 30 years and stuff like that but,most people with genotype 3,its like a 10-year period of them being,alive after that usually and,then theyre getting some kind of liver,cancer and a lot of times dying from it,um but luckily that didnt happen to me,it was very fortunate um,and they were able to administer,treatment they gave me basically gave me,the medicine because i was low income,uh i was eligible for like a a program,where the,the actual maverick company they give,you the medicine for free because it was,kind of still in a trial basis,at that time so basically theyre giving,it to people who cant afford it,to try to help get rid of hepatitis c,and,i took it for i think it was a total of,45 days,and you take three pills a day for 45,days and what,what happened was after 28 days i think,it was,i went in for blood blood work to get,blood work done,sorry ill lose my train of thought i,went in,i went in to get blood work done im,just showing my support you guys,you know got to have my baby beside me,yep and i was the one who actually,encouraged him to go to the um,not bragging or anything but i was just,very concerned,you made me get my ass up there yeah,scary you know i wanted him to help,himself but go ahead but im sorry,yeah i didnt think it cost a whole lot,for the treatment and i didnt think i,could get it,basically because its like thirty,thousand dollars but theres so many,reasons out there that resources out,there that you really dont know of,so if anybody im sorry to cut you off,but i just want to put out there anybody,else that has hepatitis c,um you are not alone we are here for you,theres a lot of people and uh,you know that theres uh a lot of,resources that you can get,whatever state youre in or whatever,country then dont even think,for a second that you cant afford it,because there is some type of resource,out there,some type of charity that can help you,get the help that you need and if you do,have,um the ability to get them pills you,know you know its a lot of money so,its 30 grand yeah but my resource was,the columbia free clinic,i went through them they put in the,paperwork with the maverick company,and the maverick company issues out the,medicine for free so basically they,they give me the two boxes of medication,they give you half of it at first you,take it,for 30 days i think and then they give,you the other half of it and you take,another box of it,so basically after 30 days i went in for,blood work and i already had,a viral load of zero meaning that i was,already cured of hepatitis c after 30,days,but you still continue to take the,medicine for i think another,15 days or something like that after,that and i continue to take the,medication so,the great news is that i was cured of,hepatitis c i dont i dont have it any,longer but i did,at that time have hepatitis c genotype,3.,now as far as side effects and things,like that,if youre wondering about that if youre,somebody out there thats thinking about,taking this medication,in my experience now ive read ive,heard about some other people who have,different experiences with it but in my,experience all i,the only side effect i experienced was,fatigue,um maybe a little soreness of my muscles,but thats about it it wasnt like,anything devastating,or like it wasnt even like as bad as,being sick or having the flu or what i,noticed was he was really tired like you,just said its real tight i dont have a,lot of energy,yeah a little less but its worth it,its worth it because i dont have that,disease anymore it saves your life,a lot of years on your life yeah like my,liver could be destroyed,you know i could accidentally give it,its very rare that oh hepatitis can be,passed sexually but i could accidentally,give it to her like she could,accidentally pick up my toothbrush,or use my razor or something like that,same thing goes for other family members,and stuff like that so its a dangerous,thing to have i also want to mention,if you have in a relationship just make,sure youre honest with your partner we,communicate with each other,so i already knew that he had so just,make sure you know if you do have,hepatitis c you know what im saying let,your partner know keep them informed you,know what im saying because,they deserve to know yeah they dont,really know like they might innocently,just be like oh we only have one razor,left ill just use,uh allens razor if they didnt know,that you had hepatitis they might just,pick it up and use it,you know and they wouldnt even think,about it so,but anyway thats the good news i want,to share with everybody um i am cured of,hepatitis c i wanted to share that with,the people who had asked me the,questions on the,you know on the maverick videos ive,been ive gotten a lot of comments from,people,who were wondering why i stopped with,the videos and were wondering whether,the medication worked,what kind of side effects it had and,things like that,um if yall want to hear more about that,let me know in the comments of this,video,if you have any specific questions about,uh,hepatitis about maverick treatment and,and what it does,just let us know down in the comments,let us know you guys i know you guys,watch our channel and i know,you guys are really enjoyed by it and,hopefully we are and if were not let us,know you know,let us know what you want to know about,maverick and,hepatitis c uh my husband is really good,on that and were here,were here to help everyone you know we,dont want to help everybody,like we are aiming towards all we dont,discriminate all shades you know what,im saying,uh i wear mentally ill he struggled with,drug addictions if we can help,you guys please let us know in the,comments down
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