Despite new treatments, obstacles remain in fight to eradicate hepatitis C

By the end of this year, thousands of people will be cured of hepatitis C, a virus that infects the liver. But while access to new, revolutionary drugs has expanded, there is still one major obstacle standing in the way of eradicating the virus entirely: the cost. An estimated 4 million Americans carry the virus, but each of those patients has the chance to be entirely cured of hepatitis C. New drug treatments are showing cure rates of about 95 percent or even higher, said Dr. Mitchell Shiffman of Bon Secours Liver Institute of Virginia.

But the cost is high. The new drugs include a 12-week pill regimen, and the wholesale price for the full treatment can range from $80,000 to $100,000.

The good news is that some insurers have started offering coverage for the new treatments, and Medicare has devoted more than $9 billion to covering the drugs for those enrolled in the program. Also, many veterans are being cured because the Department of Veterans Affairs was able to cover the cost.

But there are still a significant number of people who cannot afford the treatment, either because they are not covered or because their hepatitis C has not done enough damage to qualify them for coverage.

The virus can cause cirrhosis, or scarring of the liver, which can heighten a patient’s risk of developing liver cancer. Some insurers have restricted coverage to those who already have liver damage, rather than curing patients who have the virus but no significant liver damage.

Many state Medicaid programs — including in Virginia — also limit coverage to patients with liver damage, though there are exceptions.

That means that, in some cases, a patient with hepatitis C may have to wait until the virus does real damage to their liver before they can be cured. It also means that there are significant gaps in the fight to eradicate hepatitis C from the population entirely.

“It’s going to take many years to eradicate hepatitis C and treat everybody, but we have to treat everybody if we’re going to reach that goal,” Shiffman said.

Dr. Jasmohan Bajaj works with both VCU Health and McGuire Veterans Affairs Medical Center. He sees the cures in veterans firsthand, but also understands the reality for some patients who know they have the disease and do not have the resources to access treatment.

“It does get a little challenging for us as doctors and practitioners to face that reality,” he said. “I think that down the road things will be a little easier to handle, but right now there are a lot of people who are not able to afford it.”

Additional drugs to treat and cure hepatitis C are preparing to hit the market, and as they do the competition will likely drive costs down. That might mean that more insurers and Medicaid programs will be willing to cover the drugs for anyone with the virus, including those without cirrhosis or liver cancer.

But for those who do not want to wait, there are options. Some drug manufacturers, such as Gilead, have financial assistance programs to help with the co-pays. And the Patient Access Network Foundation is a nonprofit group that helps those with limited resources cover costs, as well.