by Amanda Conschafter, blog editor
Since 2013 a new series of medications has offered patients with hepatitis C something radical – a 90 to 99 percent cure rate. But, as a new video from the Alliance for Patient Access explains, high costs for these breakthrough medications have led government and private insurers to institute cost-savings measures that can impede access for patients.
Upfront Costs and Long-term Value
As the video notes, new hepatitis C cures are costly—but they can lower long-term expenses by reducing the need for late-state disease treatments such as liver transplants, which can cost more than $500,000. To control short-term costs, however, state Medicaid systems and some insurers have developed coverage rules that complicate patients’ access to hepatitis C cures.
Patient Access Challenges
- Extensive prior authorizations. Some patients must qualify through an extensive prior authorization process to get the hepatitis C cure they need. Such processes can include over a dozen individual requirements.
- Care rationing. Some coverage systems limit curative hepatitis C treatments to only the sickest patients, those who demonstrate stage 3 or 4 liver fibrosis.
- High co-pays. Patients may be asked to pay out of pocket for as much as 25 percent of the medications’ cost, which can run $84,000 or more.
Working Toward a Solution
Society would benefit from as many patients with hepatitis C as possible having access to curative treatments. But states, insurances companies, and employers simply cannot afford to treat everyone. Thus, the video explains, policymakers should consider several key factors:
- Mechanisms to drive down the cost of hepatitis C medications
- Co-pays that don’t impede access for patients who need hepatitis C treatment
- The need for patients to take their medications as prescribed.
To learn more, watch “Improving Patient Access to Hepatitis C Cures.”