Fewer than one-third of uninsured hepatitis C patients receive timely treatment, study shows

The researchers of the study, published on Tuesday by the US Centers for Disease Control and Prevention, found that of about 48,000 people who were tested for life-threatening diseases from the beginning of 2019 to the end of 2020, the number of those who started receiving treatment. during the year was 35% with private insurance, 28% with Medicare and 23% with Medicaid.

Hepatitis C it is caused by a virus that is spread by contact with the blood of an infected person, such as by sharing a needle for injecting drugs. Left untreated, it can become a lifelong condition that can increase the risk of liver disease, cancer and death.

CDC comparison that there were more than 2 million people in the US living with hepatitis C from 2013 to 2016, and it was listed as the cause of death in 14,242 people in 2019.

“Nearly a decade since the first effective treatment became available, we still see huge gaps in treatment for hepatitis C – a missed opportunity to improve health and prevent cancer and save lives and prevent the spread,” said Dr. Carolyn Wester, director of the CDC’s Division of Viral Hepatitis and co-author of the new study, told CNN.

High costs and insurance restrictions

The US Food and Drug Administration approved the first line of treatment for hepatitis C called interferon-free direct-acting antiviral agents in December 2013.

Professionals compare that the drug, which usually consists of pills taken orally for two to three months, cures 95 percent of people who take it, but many have struggled to find it because of its high cost.

Wester said that once the treatment was available, the cost of a two- to three-month regimen was about $90,000 per person. The price has gone down because of things like the amount of competition from other drug manufacturers, however, is a barrier to access.

He said that in order to be self-funded, insurers set limits on who can receive coverage, and those who qualify for coverage must pay out-of-pocket costs.

Some insurances have limited coverage for certain groups of patients such as those who have evidence of liver damage, have stopped taking drugs and alcohol for one month, or have been treated by a qualified physician. This though medical advice I recommend that everyone with hepatitis C get treatment, except for children under 3 years of age.
“I think there is an unfortunate, very bad prejudice against people who inject drugs, the idea that treatment is useless because if they continue to inject, they will relapse,” said Dr. Alysse Wurcel, assistant professor. is a physician at Tufts Medical Center, who was not involved in the study. “There are many education which showed that the drug is safe and effective in people who inject drugs.”

Researchers in the new study found that people whose Medicaid program implemented one of these restrictions were 23% more likely to get it. treatment within a specified year compared to those whose Medicaid program did not establish a restriction.

Getting treatment as soon as possible after diagnosis is important.

“Otherwise, people often go undiagnosed, or because hepatitis C can be asymptomatic for years, people forget or don’t know they have it,” Wester said. “And what ends up being, they don’t connect to the treatment they need, and then they appear later in the health system with advanced diseases and complications that are difficult and expensive to treat. , we have lost many years of opportunity to prevent the spread.”

The study was published in the CDC’s Morbidity and Mortality Weekly Report, which is not peer-reviewed, meaning it has not been verified by independent experts.

Years of declining drug prices

The study had limitations, including that the findings are not generalizable to people who do not have health insurance or who have a breakdown in their coverage. It also did not include information about patients in prison.

The researchers looked at ‚Äúpatients who were found to have insurance, and therefore in many ways [these] and people who are set up to have access to help and support,” Wester said in a phone call Tuesday.

Three new hepatitis C infections due to opioid epidemic

Additionally, the data were not specific enough to explain why each individual did not receive treatment. Because the study period passed with the Covid-19 pandemic, many people may not have been able to access and receive treatment due to disruptions in care. However, the rate of hepatitis C treatment has declined each year since 2015, the CDC said in an email.

“It is possible that the disruption caused by COVID-19 resulted in less support in this study; however, other long-standing barriers are also at work to prevent access to services. These include Medicaid state restrictions on the types of providers. services, restrictions on patient eligibility , and mandatory pre-treatment requirements,” the CDC added. Prior authorization is a process by which insurers evaluate whether a treatment is medically necessary before agreeing to provide a drug.

The secret to ending this epidemic

“Healthcare providers, insurers, and policymakers and health professionals all need to work to remove those restrictions,” Wester said. He added that support it should be available in more places, such as primary care offices, and that more screening should be done to identify people who may benefit from treatment.

Wurcel said he remembers the day the new drug was approved. He had written a list of patients who would try to receive the new treatment. What followed was nearly a decade of “rollercoaster” in which patients faced obstacles to access.

“The only way to end the epidemic of hepatitis C is to treat more, and one of the main strategies of many groups is to reduce the cost of hepatitis C drugs. This should be part of the strategy that aims to end hepatitis C,” he said.