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by Amanda Conschafter, blog editor

The U.S. Department of Veterans Affairs may soon join the ranks of entities curbing patient access in an attempt to balance the budget. According to the New York Times, the VA faces a budget shortfall of nearly $3 billion. To address shortages for hepatitis C treatment expenses, it offers a controversial plan: outsource veterans’ treatment and ration access to new cures.

[Related: As Cost Debate Persists, Hepatitis C Patients Go Untreated]

As reported by the Arizona Republic, the VA will transfer hepatitis C treatment for 180,000 veterans to private health care providers through the Veterans Choice Program. The move allows veterans to access pricey hepatitis C cures without the VA having to request “bailout money” through last year’s Veterans Access, Choice and Accountability Act. The choice program was originally intended to reduce the waitlist of veterans who needed health care.

As a result, affected veterans may now face several barriers. Ineligible for treatment at their regular site of care, they must search outside the VA clinic for a private provider.  Moreover, that provider may need to be a liver specialist; in some cases hepatologists or gastroenterologists are the only physicians authorized to prescribe hepatitis C cures.

Seeing a specialist can require the veteran to wait weeks or even months for an available appointment. Getting to the specialist’s clinic may then necessitate travel, depending upon where the veteran lives. Elderly or disabled veterans may need a friend or family member to help with transportation.

The outsourcing solution also rations access to hepatitis C cures to keep costs down. Veterans with advanced disease take priority, while those exhibiting “persistent vegetative state or advanced dementia” may be denied hepatitis C treatment altogether.

The proposal has prompted outrage from veterans advocates. Tom Berger of the Vietnam Veterans of America called the idea a “faulty plan.” Meanwhile, 200 specialists from the Veterans Health Administration wrote to Secretary Robert McDonald that “To halt hepatitis C treatment at VHA facilities now would be unconscionable. We can and must end the epidemic.” The VA’s director of HIV, Hepatitis and Public Health Pathogens Programs resigned from the working group responsible for the transition plan.

The plan reflects the VA’s ongoing challenge: increasing costs for treatment and continued growth in the number of veterans who need care. Just one year ago, reports of extensive waiting lists of veterans needing health care sparked public outrage and congressional action. Though the VA responded by handling 2.7 million more appointments and accepting 900,000 additional patients, the number of veterans needing care – and the extent and cost of the care they need – continues to overwhelm available funding.

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