What employers can do to help eradicate Hepatitis C
February 20, 2024
Reported cases of Hepatitis C, 2014-2021
Source: Centers for Disease Control and Prevention, 2023 LINK
Hepatitis C, a virus that was only identified in 1989, is a leading cause of liver failure and liver cancer, and substantially increases likelihood of premature death. It is spread through blood and bodily fluids, so many cases were from blood transfusions prior to 1989, although more recently most cases are associated with intravenous drug use and sexual transmission.
New drugs that can cure Hepatitis C were launched in 2011, and there is now medicine that is highly effective at curing all subtypes of Hepatitis C with just 8-12 weeks of therapy. Infectious disease experts were exuberant at the approval of this new class of medicines, believing we could eliminate this disease, or make it very rare. These drugs also led to consternation, as the initial launch price was over $90,000 per person. At the time, I felt that this was a “value based” price, as a previous drug with a success rate of about 30% and more adverse effects cost about $30,000. Employers were not anxious to spend $90,000 per Hepatitis C cure. States were restrictive and did not offer treatment to many of those on Medicaid or who were incarcerated and would have benefited.
There are six different agents available for treating the various phenotypes of hepatitis C with the prices for brands and authorized generics ranging from $25,000 to $90,000 per treatment course with most the majority of coverage and utilization for lower cost products.
But we are not treating nearly enough people. There are about 2.4 million in the US with active Hepatitis C, and only 1 million have been treated since these drugs became available. As many as three quarters of those with Hepatitis C don’t know they are infected with the virus, making it more likely they will transmit it to sexual partners or other intravenous drug users. It’s exasperating to see cases of Hepatitis C going up when we have such effective drugs to treat the disease and prevent new cases.
Some employer sponsored health plans have restrictions on treatment for Hepatitis C, for instance requiring members seeking treatment to be drug-free and to be abstinent from alcohol. The current treatment guideline “strongly asserts that active or recent drug use or concern for reinfection is not a contraindication to HCV treatment.”. Unfortunately, these restrictions could mean those who are denied treatment are likely to spread Hepatitis C to others. Eradication appeared to be in sight in the early 2010s, but now seems far away.
The Biden Administration put a $12.3 billion program to eliminate Hepatitis C by 2030 in the 2024 federal budget, although this budget remains in Congressional gridlock. Researchers estimate that this program could avert 24,000 deaths and decrease total health care spending by $18.1 billion over ten years.
Implications for employers:
Employers can review coverage policies with their pharmacy benefit manager to ensure adequate access is available for Hepatitis C treatment. The WTW Pharmacy Team can help our clients address this issue.
The US Preventive Services Task Force recommends one-time screening for all adults, which should be covered without cost sharing. Those at high risk should be tested periodically, although this testing would be subject to cost sharing.
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Tomorrow: Cancer is increasing in young people, but remains rare