Sunday, April 17, 2016

Sunday Globe Special: Break of Day

I'm usually up before it....

"Hepatitis C drug costs leave many without care" by Felice J. Freyer Globe Staff  April 09, 2016

Twenty years ago, Larry Day learned two dangerous viruses were circulating in his body, HIV and hepatitis C. Both infections came from needles shared during his years as an injecting drug user.

Only one caused him big problems: hepatitis C. That virus destroyed his kidneys, an uncommon complication. Over time, he knew, hepatitis C could lead to cirrhosis and liver cancer. So when drugs came on the market promising to cure him, Day — by then free of illicit drugs — was eager to give them a try.

But his Medicaid insurance plan said no. He could get the drugs only if his liver was damaged, and his liver was still in good shape.

The restrictions Day faced violate a federal directive, run contrary to medical guidelines, and undermine an opportunity to stop the spread of an infectious disease. But MassHealth, as the Massachusetts Medicaid program is known, is not alone in putting up obstacles to hepatitis C drugs.

Hepatitis C treatment costs tens of thousands of dollars per patient. The illness progresses slowly over decades, so most states’ Medicaid programs control costs by treating the sickest first and requiring others to wait.

The conflict over hepatitis C drugs, such as Sovaldi and Harvoni, heralds a challenge likely to persist into the future, as new drugs for other illnesses thrill doctors and patients with their effectiveness — and scare health plans with their prices.

Hepatitis C is a big concern for government, because it disproportionately affects low-income people, who are more likely to be on Medicaid, and prisoners, whose care is also the state’s responsibility.

Encouraged by Obummercare, and this is the reason we are getting rationed health care!

After months of appeals, Day, who lives in Boston and whose HIV infection is controlled by medication, got the hepatitis treatment. His doctor, Arthur Y. Kim at Massachusetts General Hospital, persuaded the insurance company that managed his Medicaid coverage to pay for the treatment.

They aren't even cut out of the government program.

So last summer, the 58-year-old swallowed one pill a day for three months, and when he was done, the virus was gone. When Kim told him hepatitis C was in his past, Day recalled, “I was like, ‘Are you kidding? How cool is that!’ ”

Rarely do physicians get to tell patients they have been cured of a chronic illness — but that is what happens for more than 90 percent of hepatitis C patients who take the drugs. The previous treatments cost more, had severe side effects, and worked only 40 percent of the time.

“This is transformative for people,” said Dr. David S. Yassa, an infectious-disease specialist at Beth Israel Deaconess Medical Center. “In many ways, it’s one of the most rewarding things that you can do.”

No wonder the prices shot up! 



But while some get the cure, many others have to get sick before they can get better. The majority of Medicaid programs require evidence of liver damage before they approve treatment. Patients who are turned away often wait in the shadows, because hepatitis C primarily strikes people who injected drugs.

“Stigma plays a huge role in this,” said Ryan Clary, executive director of the National Viral Hepatitis Roundtable, an advocacy group. “If it were another disease that didn’t have the same sort of stigma, I don’t think we’d have the same conversation.”

A Boston woman in her 60s, who became infected during what she described as a brief flirtation with drugs 20 or 30 years ago, agreed to an interview but didn’t want even her first name published. She said MassHealth/Neighborhood Health Plan would not cover her treatment because she remains healthy, so she lives with hepatitis C and hopes for the best.

“I’d think they would want to prevent me from becoming sick,” she said.

Baby boomers who used drugs in their youth, or who had blood transfusions before a screening test became available in 1992, could produce an epidemic of liver disease as they age. Massachusetts law says primary care physicians must offer a hepatitis C test to all patients born between 1945 and 1965.

Another age group presents new reason for concern — young people who inject drugs. In Massachusetts, hepatitis C infections among 15- to 29-year-olds increased 37 percent from 2007 to 2014, even as the number of cases overall remained steady.

Yet the MassHealth managed care organizations, along with half of the nation’s Medicaid programs, will pay for the drugs only if a person has stopped using alcohol and illicit drugs, for fear patients will be reinfected. Health professionals estimate only 2 percent become reinfected. Meanwhile, drug users who remain untreated may continue to spread the illness....

Only at the very end do they begin to discuss the price-gouging by pharmaceuticals responsible for the whole thing.


RelatedMass. bill seeks to rein in prices of some drugs

Then they got to him.

Well, day is starting to break out there so off I go to get a Bo$ton Sunday Globe.