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Medicare Struggling With Hepatitis-C Cure Costs

WebMD News from Kaiser Health News

By Richard Knox

Fri, May 09 2014

UPDATE, 5/15/14: Medicare Reverses Denial Of Costly Treatment For Hepatitis C Patient

Walter Bianco has had hepatitis-C for 40 years, and his time is running out.

"The liver is at the stage next to becoming cirrhotic," the 65-year-old Arizona contractor says. Cirrhosis is severe scarring, whether from alcoholism or a chronic viral infection. It's a fateful step closer to liver failure or liver cancer.

If he develops one of these complications, the only possible solution would be a hard-to-get liver transplant. "The alternative," Bianco says, "is death."

Previous drug treatments didn't clear the virus from Bianco's system. But it's almost certain that potent new drugs for hep-C could cure him.

However, the private insurer that handles his medication coverage for the federal Medicare program has twice refused to pay for the drugs his doctor has prescribed.

Doctors are seeing more and more patients approaching the end-stage of hep-C infection. "There isn't a day that goes by when I don't have a story very similar to Mr. Bianco's," says Dr. Hugo Vargas of Mayo Clinic in Scottsdale, AZ, his liver specialist.

Researchers estimate that 3 to 5 million Americans carry the insidious hep-C virus. The biggest concentration is among those born between 1945 and 1965.

Many, like Bianco, got hep-C from injecting street drugs in their youth. He says he's been drug- and alcohol-free for 32 years, but the infection was permanent.

Other baby boomers got the virus from transfusions before 1992, a period when blood wasn't screened. Some got it from sharing razors or toothbrushes, or from contaminated tattoo needles or hospital equipment. For some, transmission was sexual, although fortunately this isn't the highest-risk route.

The timing of these infections spells trouble for Medicare, which insures Americans over 65.

Hepatitis-C is a slow-acting virus. Over a period of 20 to 40 years, it causes liver damage in about 70 percent of people it infects.

A growing number of people who got infected in the 1960s through the 1990s have now "used up" the infection's latency period, notes Dr. Camilla Graham of Beth Israel Deaconess Hospital in Boston, "which is why we're now seeing this dramatic increase in the number of people developing complications and dying of hepatitis. And we expect this to continue to increase for the next 10 years."

Is A Cure Worth $84,000? 

Another part of Medicare's problem is that new hep-C medications are among the priciest of any drugs. One called Sovaldi, federally approved last December, costs $1,000 a pill - or $84,000 for a typical 12-week treatment course. The other recently approved drug, Olysio, costs around $66,000. Others in the pipeline are expected to be similarly expensive.

"People were very shocked about the price because it hit a psychological barrier in terms of  'this is too expensive,'" Graham says.

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