Full Answer
Is Medicaid keeping Americans from being cured of hepatitis C?
Hepatitis C is our nation's deadliest infectious disease, yet many state Medicaid programs have discriminatory restrictions that keep Americans from being cured and stop us from ending the epidemic.
Should restrictive state policies on hepatitis C treatment be reassessed?
Current restrictive state policies regarding HCV treatment in Medicaid populations must be reassessed in light of these data. A restrictive Medicaid policy in many states limits hepatitis C virus (HCV) treatment to patients with severe disease, leading to suboptimal treatment outcomes, high patient burden, and excess costs.
What is the hepatitis C Medicaid affinity group?
The Hepatitis C Medicaid Affinity Group (Affinity Group) aims to increase the number and percentage of Medicaid beneficiaries diagnosed with hepatitis C virus (HCV) who are successfully treated and cured.
Do you need a diagnosis of chronic hepatitis C to access treatment?
For example, some states require a diagnosis of chronic hepatitis C to access treatment, despite the AASLD/IDSA guideline recommendation to treat both acute and chronic hepatitis C. 5
Do Most insurances cover hep C treatment?
Most health insurance plans require treatment for HCV to be medically necessary. Whether or not treatment is medically necessary depends on each plan's coverage policy.
What is the average cost of hep C treatment?
The cost of hep C treatment varies depending on the type of drug. However, an 8- to 12-week course can range from $54,000 to $95,000 (or higher). For example, the price of a 12-week course of Zepatier can be as much as $54,600, and a 12-week course of Harvoni can cost as much as $94,500.
Who qualifies for hep C treatment?
With the exception of pregnant women, the World Health Organization recommends treatment be offered to all individuals aged 12 years or older diagnosed with HCV, regardless of their disease stage.
Does Obama Care cover hep C treatment?
Providing free preventive care. Under the ACA, all new health plans must cover certain preventive services—like shots and screening tests—without charging a deductible or co-pay. This includes important viral hepatitis services such as hepatitis A and B vaccination and hepatitis B and C testing.
Will Medicare pay for hep C treatment?
Medicare covers screenings to detect hepatitis C, often at no cost. Medicare Part D plans must include at least one hepatitis C treatment medication. These prescription drugs are often still expensive if you don't have a low-income subsidy to help pay for them.
Is hep C treatment affordable?
A 2018 study found that a single pill of one hepatitis C drug cost $1,000. The total was $84,000 for its 12-week course of treatment. Another drug cost $23,600 per month. That's for treatment that could take 6 months to a year.
What is the success rate of hep C treatment?
Hepatitis C treatment can cure more than 90 percent of hepatitis C cases, but testing is a critical first step. It's estimated 40 percent of people with hepatitis C in the U.S. from 2015-2018 were unaware of their infection.
How long can you live without hep C treatment?
Like the human papillomavirus (HPV), early acute hepatitis C can clear on its own without treatment; this happens about 25% of the time. However, it's more likely that the virus will remain in your body longer than six months, at which point it's considered to be chronic hepatitis C infection.
When do you initiate hep C treatment?
Because of the many benefits associated with successful HCV treatment, clinicians should treat HCV-infected patients with antiviral therapy with the goal of achieving SVR, preferably early in the course of chronic hepatitis C before the development of severe liver disease and other complications.
Does Florida Medicaid cover hep C treatment?
Development: Florida makes hepatitis C treatments more widely available to Medicaid recipients. Florida is making hepatitis C treatment more widely available to its Medicaid recipients.
Does Texas Medicaid cover hep C treatment?
Starting on September 1, 2021 – if you want your doctor to give you treatment for Hepatitis C, Medicaid may cover the medicine you need without considering the level of your illness, the specialty of your doctor, and without any need to have a drug screening.
What is out of pocket maximum?
The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits.
How many people are cured of HCV?
New HCV treatments can result in a cure for approximately 95% of people who take them. People who are cured of HCV experience multiple health benefits and are significantly less likely to develop severe liver disease, liver cancer, and liver failure, which are often very costly conditions. Eliminating hepatitis requires increasing access to screening, diagnosis, and early HCV treatment, which together will save lives, reduce new infections, and control health care costs. These goals are described in the The Viral Hepatitis National Strategic Plan: A Roadmap to Elimination 2021-2025.
What is the Medicaid affinity group?
The Hepatitis C Medicaid Affinity Group (Affinity Group) aims to increase the number and percentage of Medicaid beneficiaries diagnosed with hepatitis C virus (HCV) who are successfully treated and cured.
Liver Disease Progression
Thanks to this restriction, patients are required to reach a certain stage of fibrosis before being eligible for treatment in the Medicaid program. “Fibrosis is the amount of damage done to your liver measured on a scale of zero to four with zero meaning no scarring and four essentially being liver failure,” Waters says.
Substance Use and Sobriety Requirements
Patients with a history of substance or alcohol abuse need to show they are free of drugs or alcohol before they are approved for treatment under Medicaid.
Prescriber Restrictions
Only certain specialists are allowed to prescribe DDAs. Which, in theory, sounds feasible, however, “in a state like West Virginia where there’s one hepatologist in the entire state, it starts to make sense why there’s a bottleneck for an entire cohort of patients that need this treatment,” Waters says.
Progress Makes Perfect
Sobriety restrictions remain the most pressing and widespread barrier to accessing hepatitis C treatment.