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When it comes to curing hepatitis C, the United States is at the bottom of the barrel.

A 2019 International Liver Congress ranking reveals that some of the world’s highest-income countries have made the poorest progress toward eliminating hepatitis C.  Even though curative treatment is available, “80% of high-income countries and territories are not on track to meet the WHO’s targets,” according to reports from the congress.  

Two-thirds of countries are off track by 20 years or more, though the United States ranks last.  At the top of the list are several European countries, including Spain, the United Kingdom and France, as well as Australia. The World Health Organization established global elimination by 2030 as a goal in 2016.  

The United States’ low ranking is more than just cause for international embarrassment.  It reflects the ongoing access challenges faced by U.S. patients with hepatitis C, even six years after direct-acting antiviral cures for the chronic disease became available.  

As prices for hepatitis C cures have continued to tumble, some insurers and Medicaid systems have reduced access barriers.  In 2018, for example, Governor Andrew Cuomo launched a statewide initiative to eliminate the disease in New York.  In his announcement, Gov. Cuomo acknowledged the impact of burdensome prior authorization that can delay treatment until patients are in the later stages of the disease.  

Illinois has also made strides.  After earning a “D-” for its restrictive access policies, Medicaid officials reconsidered the state’s 17-step prior authorization process.  Following a meeting arranged by Alliance for Patient Access that included Medicaid officials, members from the Hepatitis Therapy Access Working Group and other leading physicians, officials expanded treatment access to patients in the earlier stages of the disease.  

In other instances, however, it’s taken legal action for patients to finally get cured – especially for inmates of state prisons.  In April, for example, a Florida judge determined that the state’s department of corrections must now screen and treat infected inmates, regardless of their stage of liver fibrosis.  Late last year, Colorado’s state department of corrections was similarly instructed to treat the state’s 2,200 inmates with hepatitis C – after several infected inmates filed a class action lawsuit.

States have repeatedly cited the high cost of direct-acting antiviral treatment as rationale for delaying or withholding cures for hepatitis C.  But the costs of not acting may be far higher. A 2017 report from the National Academies of Sciences, Engineering, and Medicine predicts “tens of thousands of deaths and billions of dollars in wasted medical costs” if policymakers don’t work to eliminate the infectious disease.

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