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Insurers Seek $200 Billion for Hepatitis C Treatments

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Sarah Kim4 years ago

New debates on how much the U.S. can spend on new, and more expensive, medications have begun.

Insurers Struggle to Budget Costly Hepatitis C Treatments

According to Reuters, multiple U.S. Health Insurers currently administering healthcare plans for California’s Medicaid program are asking for the nation’s assistance in funding treatments for patients with Hepatitis C. More than 9 million of the 62 million people who receive Medicaid benefits in the U.S. live in California.

In particular, insurers seek Sovaldil (sofosbuvir), which is produced by Gilead Sciences Inc. and costs around $84,000 per patient.

The new generation of hepatitis C treatments could cost the nation more than $200 billion in the next five years with states like California considering a combination treatment of Sovaldi, and the drug Olysio (simeprevir) from Johnson & Johnson that can exceed $150,000 per person.

Gilead and other health experts state that the treatments are worth the hefty prices, because it can cure almost all of the patients who adhere to the 12 week course of medication. The drug also has the potential to prevent liver disease in the 3.2 million U.S. Hepatitis C patients, and may allow them to avoid repeated use of other therapies. But the actual cost may be higher.

Some patients may require a combination of other drugs for the treatment to be the most effective. AbbVie Inc and Bristol-Myers Squibb Co have developed oral treatments for hepatitis C with cure rates in excess of 90 percent recorded in clnical trials. Merck & Co and Vertex Pharmaceuticals are also working on new products.

However, Medicaid is already struggling after multiple budget cuts and the rise of public-sector costs.

A spokesman with the California Department of Healthcare Services in Sacramento stated “The challenge is providing the most appropriate treatment for medical members that is also fiscally sound.” In a phone interview, Cava said several requests have been made to separate the medication from the insurers’ plans. The state would directly reimburse patients for the cost of the medications.

Later this year, the FDA is expected to decide on a Gilead combination drug with a similar effect.

Information Regarding Hepatitis C

The following information is provided by the Centers for Disease Control & Prevention (CDC):

  • Hepatitis C is a liver disease that results from infection with the Hepatitis C virus.
  • It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness.
  • Hepatitis C is usually spread when infected blood from a person enters the body of a healthy individual. 
  • Hepatitis C can be either “acute” or “chronic.” Acute Hepatitis C virus infection is a short-term illness that occurs within the first 6 months after exposure to the infection. Chronic Hepatitis C can result in long-term health problems, or even death.
  • There is no vaccine for Hepatitis C. The best way to prevent Hepatitis C is by avoiding behaviors that can spread the disease, especially injection drug use. 
  • It can take 20 to 30 years for the virus to develop into more serious health problems such as cirrhosis or liver cancer and is the main cause of liver transplants.


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