The high cost of therapy for patients with chronic hepatitis C (HCV) infection has been an important topic of discussion for key stakeholders in pharmacy benefit design and management. Multiple effective treatments have been introduced, with cure rates approaching 100%.
Although costly, curing HCV early on can prevent serious liver complications, such as hepatic cirrhosis, organ failure, and cancer, for the approximately 2.7 million affected people in the United States.
In 2016, there was a downward cost and utilization trend for the HCV Specialty category. Express Scripts reported in its 2016 Drug Trend Report that utilization of HCV therapies had decreased by 27.3% and the unit cost had decreased by 6.7%. The cost per member per year (PMPY) for HCV drugs decreased to $25.26 PMPY from $38.44 PMPY the previous year.
Why have cost and utilization suddenly decreased after two years of steady growth?
Changes from the Patient Protection and Affordable Care Act (ACA) are dominating the healthcare landscape. These changes are very important for people infected with the hepatitis C virus (HCV). Last year there was an increased federal public health effort aimed at diagnosing people with HCV. Baby Boomers, the generation with the most HCV-infected people, has started to become eligible for Medicare.
Further, new treatments for HCV are under development. Undiagnosed individuals and uninsured individuals may represent a population that payors and stakeholders have not yet experienced. This paper discusses how increased diagnosis, increased Medicare eligibility, and newly insured individuals with HCV will affect the U.S. healthcare system.
The Concord Monitor is running a series on hepatitis C (HCV) . A first-person article written by a carrier and published today frames the challenge:
HCV is often called “the silent epidemic” because many carriers have no idea they’re infected, and most people have never heard of the disease. But silent doesn’t mean benign. Left untreated, it can cause serious liver damage and liver cancer, and it is the leading cause of liver transplant in this country. It kills about 10,000 Americans a year, and the National Foundation for Infectious Disease predicts that number will triple in the next 20 years as more and more carriers reach end-stage liver disease.
The economic costs are staggering, too. A report released last year by the actuarial firm Milliman Inc. estimates that HCV patients in the U.S. require about $30 billion in medical care annually. The price tag will grow over the next two decades, according to the study, costing public and private health insurers $85 billion a year by 2027. Because the majority of HCV-positive Americans are baby boomers, Medicare will be responsible for nearly half the bill.
The New York Times considers the long-term implications of hepatitis C and the efforts to treat it with drugs that are now becoming available. Here is an excerpt:
But even if the [hepatitis C] drugs do work, some experts and doctors warn that this virus may be particularly tough to vanquish. Three-quarters of the people who are infected do not know it because they are not tested for the virus and because the infection can be asymptomatic for years while it stealthily attacks the liver.
And because this disease is transmitted by blood, those infected largely are former or current IV-drug users — a population that characteristically has little or no health insurance — who may not be the most able to stick to a lengthy treatment regimen that can cause brutal side effects…
Vertex has commissioned studies projecting a rising toll from hepatitis C. One such study, done by Milliman, a health insurance consulting firm, projected that the number of people with advanced liver disease from hepatitis C would quadruple in 20 years if treatment did not improve.
The Milliman report is available here.
The House Oversight and Government Reform Committee yesterday considered a bill to improve detection and treatment of hepatitis C. Here is an excerpt from the testimony of Louisiana congressman Bill Cassidy:
While new HCV infections have declined over the past two decades, there are at least 3 million Americans with chronic HCV. According to the 2009 Milliman Report, Consequences of Hepatitis C Virus: Cost of a Baby Boomer Epidemic of Liver Disease, most of our infected population are baby boomers.
Newsweek has released a new article looking at the coming Hepatitis C epidemic. Here is an excerpt:
Hepatitis C is a serious challenge for both doctors and public health officials, largely because of its long incubation period. An individual infected with hepatitis C can live the majority of their life not knowing they were infected. In fact, the new IOM report suggests this is usually the case: 75 percent of those with hepatitis C don’t even know they have it. And unlike other forms of the hepatitis virus, like A and B, there is no known vaccine. So the virus continues to be transmitted through exposure to infected blood, often injection drug use. Boomers may have also become infected by a blood transfusion or organ transplant before 1992, when officials began screening the blood supply for the disease.
Of those infected with the virus, about 60-70 percent will develop chronic liver disease. For about 40 percent, a months-long regimen of shots and pills will eradicate the virus. But many will continue to live with the disease as a chronic condition; 1 to 5 percent will die of the consequences of liver disease. Some expect to see these conditions become significantly more prevalent as Boomers’ cases move from virus to disease. One study, a Milliman Report published in May 2009, predicted that the number of patients with advanced liver disease will be four times greater than it is today by 2029. Cases of cirrhosis, scaring of the liver, will also quadruple.
Read the Milliman study here.