Medicare balks at high costs for new hepatitis C drugs

Hepatitis C, a viral infection of the liver that is slow acting but eventually devastating in most who have it, is presenting a new problem for Medicare as more with the infection live beyond its latency period.

by John Tyburski

Copyright © Daily Digest News, KPR Media, LLC. All rights reserved.

First published at Daily Digest News on May 12, 2014

Experts estimate that hepatitis C virus (HCV) infects three to five million Americans. The largest proportion of HCV infections are in the baby boomers, or those born between 1945 and 1965. These individuals are beginning to hit the age of 65, the age at which they qualify for health care coverage under the Medicare program. As they reach 65, many who have been living with HCV will present with liver problems that will place a greater financial burden on Medicare.

There are several reasons for why the baby boomer generation has a high proportion of HCV infection. The virus is transmitted via dirty drug needles, razor blades, and tattoo equipment. It is also, to a lesser extent, transmitted through sexual activity. Baby boomers engaged in more risky behaviors than previous generations at a time when less was known about the health risks of HCV. Some boomers were infected with HCV when they received infected blood via transfusions. It was not until 1992 that donated blood was tested for HCV.

Hepatitis C is slow to cause liver injury but after a period of 20 to 40 years, those who will suffer liver problems from it begin to do so. Infection with HCV is associated with a fairly high risk of cirrhosis or liver cancer. Because of the latency and routes of transmission, HCV infects the young and affects the old. If an infected person also consumes alcohol, the risk for these adverse health outcomes grows exponentially.

Two relatively new drugs for treating HCV are on the market at extremely high prices. Sovaldi costs as much as $1000 per pill and $84,000 per 12-week treatment regimen. Olysio is not much cheaper, coming in at a complete treatment price tag of $66,000. The real kicker though is that the two drugs used in combination show nearly a perfect cure rate. However, the FDA has yet to approve the combined therapy. And Medicare and its private contractors are denying coverage, citing the high costs as being prohibitive.

For 65-year-old Arizona resident Walter Bianco, who has hepatitis C for 40 years, time is running out.

“The liver is at the stage next to becoming cirrhotic,” he said in an interview. Together the two new drugs would cost around $150,000 for a complete treatment regimen, which is far more than Bianco can afford.

“It is a lot of money, and there are a lot of hep C sufferers out there,” Bianco says. “I think Medicare’s probably thinking. ‘If we can hold off for a year or two, some of these following drugs will be cheaper.’ “