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New Drug Can Cure Hepatitis C – If Only We Could Afford It

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The pill is called Sovaldi and it’s profoundly changing outcomes for Hepatitis C patients.

Just 5 years ago the cure rate for most patients in the US was about 50%. Now with Sovaldi, made by Gilead Sciences Inc. of California and approved by the FDA last December, the latest Hep C regimen is making therapy shorter, more tolerable, and the cure rate is reaching 95-100 %.

That’s significant for West Virginia, which has the second highest prevalence of Hepatitis C in the country.

Hepatitis C is a blood-born disease primarily affecting the liver. It spreads today mostly among drug users sharing needles, although some were infected before widespread screening of the blood supply through transfusions and transplants.

The virus is also transmitted through poorly sterilized medical equipment, sometimes found in tattoo parlors, and in rare cases it’s transmitted through sexual activity, or from mother to newborn.

Sovaldi is a blessing that comes with a staggering price tag. Therapy usually lasts 12 weeks, but it could take 24. It’s one pill a day and costs $1000 a pill. That comes to $84,000 per 12-week treatment.

Even with the 23.1% discount that the program receives from drug companies, Sovaldi could be a budget-buster for West Virginia’s Medicaid Program, which provides healthcare to 540,000 West Virginians, 16,000 of whom have Hepatitis C.

So the Bureau of Medical Services, like state Medicaid programs across the country, is restricting coverage – establishing pre-authorization criteria that a patient must meet before the government will pay for the drug.

West Virginia’s criteria are stricter than some states, more lenient than others. The patient must be alcohol and drug free for 3 months prior to treatment and committed to staying substance free. 

The rules also limit the drug to sicker patients - patients who have reached a certain level of liver fibrosis, or scarring.

James Becker, MD, Medical Director for the West Virginia Medicaid Program, says prioritizing is necessary in a public payer system that is responsible for the treatment of multiple serious and chronic diseases and conditions.

But physicians want to treat their patients before any signs of fibrosis.

It’s estimated to it would cost 1.4b this year to treat all of West Virginia's Medicaid recipients who have Hepatitis C.

The state's Medicaid pharmacy budget is approximately $350 million annually.

As of early October, Medicaid had received 100 requests by physicians for Sovaldi treatments.

Fourteen were approved,  86 were denied.


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