How are the sky-high costs of hep C drugs shaping who gets treated?

Published on
December 3, 2015

When the hepatitis C treatment Sovaldi hit the market in December 2013, people were shocked by both the drug’s effectiveness and its price. The drug was said to cure the deadly liver virus in more than 90 percent of patients — at a cost of $84,000 for a 12-week treatment.

More hepatitis C treatments have since hit the market, and they’re also both staggeringly effective and expensive. This has sparked a nationwide discussion about the high cost of specialty drugs and who should have access to them.

Health advocates argue everyone should be able to take advantage of the new generation of treatments. They say that eliminating the virus also eliminates the possibility of transmission. That’s especially true, they say, among people with the highest rates of hepatitis C transmission, like intravenous drug users and HIV-positive men who have sex with men.

But that’s not occurring in California. As of 2013, an estimated 750,000 people were living with chronic hepatitis C in California, according to the state department of public health. Statewide, though, just about 2,150 Medi-Cal enrollees were treated for hepatitis C in 2014, advocates say.

The state expanded access to these life-saving treatments in July and more people have been gaining access to these drugs since then. Still, providers at community health centers tell me it’s frustrating prescribing these drugs to people who need them, only to have the authorization requests repeatedly denied or delayed.

As part of the 2015 California Data Fellowship, I will obtain available data on hepatitis C prescription authorization trends. My goal is to paint a picture of how the high cost of these drugs is impeding Californians’ access to them. I will also dig into the economic and public health costs of denying the drugs to people with this deadly condition.

I’ll obtain data from state health agencies on how often these prescriptions are prescribed, denied and appealed, and the results of these appeals. I’ll also reach out to insurance companies, to request health care utilization data for people with chronic hepatitis C. This information will help us depict the cost of not treating people for this disease.

After obtaining and analyzing this data, I’ll work on a series of multimedia stories depicting how limited access to critical hepatitis C treatments impacts individual patients, providers and communities. I’ll also analyze the short- and long-term effects of these costs on the state and insurers.

These new hepatitis C medications have become a flashpoint in the national conversation about skyrocketing drug prices. But they’re just one of many costly drugs on the market today. Understanding how public and private insurers are covering hepatitis C drugs, and how these decisions impact individuals and the wider community, could provide lessons for how our society deals more broadly with the rising cost of prescription drugs.

[Photo by Chris Potter via Flickr.]