Health Care Rationing and the Politics of Hepatitis C

Hepatitis-C-5065By: Dr. Frank MacMillan, MD

Back in April, I wrote about anticipated new treatments for Hepatitis C viral infection. The first all-oral treatment was FDA approved on October 10, with additional new medications expected before this year’s end. These new medications not only treat, but they actually cure Hepatitis C in almost everyone who takes them as directed, often in as little as 8-12 weeks. This should be cause for celebration. But not everyone is celebrating.

his medicine is very expensive, and I will say with certainty that the insurance industry is looking at ways to deny or delay access to this disease ending and life saving treatment. Expensive, overpriced, price-gouging are words often heard in these discussions. While there is no doubt that the medication is expensive at $1000/day, the infection is cured at a cost of $56,000 to $180,000 depending on how advanced the disease is. As shocking as those numbers sound, they are hardly out of range for cancer care, joint replacement, organ transplant, major surgery or a major hospitalization in the intensive care unit.

Consider that there is a stigma associated with Hepatitis C infection. Hepatitis C is a blood born virus infection. Common ways the infection is acquired is by blood transfusion, tattoo, intravenous drug use, and nasal cocaine use. Many people do not recall behaviors that could have put them at risk. For this reason, the US Preventative Health Services Task Force now recommends universal screening of all adults born between 1945 and 1965. In some cases that I see, a long ago lapse in judgment occurring in their teens or twenties has left a lifelong reminder of that indiscretion and serious health consequences. There is a feeling among some that those who have the infection somehow deserve it and do not deserve care or our concern. This was also exactly the situation in the early days of the HIV epidemic. Very quickly political pressure built to de-stigmatize HIV infection. Highly effective treatments were soon available that changed the disease from a death sentence to a chronic condition that can be treated and lived with. These HIV medications are also not cheap, and it is necessary to remain on them for life. The cost adds up over time. With Hepatitis C treatment, there is no need for maintenance treatment. It’s a “one and done.” Could it be because of the stigma associated with Hepatitis C infection, that the insurance companies think they can get away with rationing access? I don’t know for certain, but I have concerns.

The treatments may be new, but the people who I take care of have had the disease for many years if not decades. They have been waiting patiently for effective and tolerable treatments. The doctors who care for patients with Hepatitis C are also working tirelessly on advocacy for those who suffer. Patients who need treatment should not quietly accept denials of payment by their insurance companies. They should appeal at all levels, write letters, work with their employee benefits managers, and pull all political levers to be sure that no one who has been paying insurance premiums for health coverage is denied effective treatment because of prejudice or stigma related to this illness.

Our country spends a lot of money on health care services; some of it is of questionable benefit. Where we spend our money is also in part driven by political considerations. Perhaps people with Hepatitis C are considered insufficiently deserving of our attention. Unfortunately, that is the attitude of some folks. The reality is that people from all walks of life get Hepatitis C, and they are no better or worse than the rest of us. When so called non-profit insurance companies, who have no problem spending millions of dollars on executive compensation, luxury boxes at sporting venues and political lobbying, can get away with denying or delaying effective treatment because of perception of cost and the prevailing stigma associated with Hepatitis C infection, they deserve to be called out on their bad behavior. Curing Hepatitis C stops the spread of the infection, relieves suffering, and restores health. For me, that’s the whole reason we do what we do. It’s money spent once, and money well spent.

mACmILLANDr. MacMillan specializes in Gastroenterology and Liver disease and is a member of the North Andover Board of Health. He practices at Holy Family Hospital and currently serves as President of the Massachusetts Gastroenterology Association. Dr. MacMillan was recently reelected as Massachusetts Governor of the American College of Gastroenterology and is a Fellow of the College.