For many patients with an infectious disease, a cure can’t ever be more than a dream. But for Oregonians living with hepatitis C, that’s changing.
The state has decided to loosen its Medicaid restrictions related to liver damage. Covered patients can now begin treatment when they develop mild liver scaring, rather than waiting to reach advanced stage fibrosis. The disease progressively damages the liver and can lead to cirrhosis, liver cancer or death. The treatment, direct-acting antivirals, yield a 95 percent cure rate.
One physician applauded Oregon’s policy change in a recent interview with PBS NewsHour. “From a public health standpoint,” Brianna Sustersic, MD, explained, “if we are able to treat the population who is contracting this [hepatitis C], and spreading it, then we can move toward eradicating the disease.”
Curing infected patients is certainly the first step, as it prevents new infections. Given the availability of direct-acting antivirals, the U.S. should be well on its way to disease eradication. But it’s not.
Medication access restrictions by private and state Medicaid insurers alike, coupled with the nation’s opioid epidemic, have actually led to increased rates of new hepatitis C infections across the country.
Despite direct-acting antivirals’ public health benefit, recent research found that more than half of patients with commercial coverage had their prescription denied. Medicaid also denied patients 35 percent of the time.
Several states, however, have made a committed public health decision to increase the availability of hepatitis C cures. Colorado, for example, also lifted its requirement for patients to demonstrate advanced stage liver disease before becoming eligible for treatment. Officials cited the declining cost of the medication as their reason for increasing availability. The price has come down by almost 70 percent since direct-acting antivirals first came on the market in 2013.
For the benefit of individual patients and public health alike, more states should follow suit.