Hepatitis C is a virus that affects the liver, often causing liver cancer or cirrhosis. Although they share a name, it is completely different from hepatitis A or B so current hepatitis vaccines don’t guard against hep C.
The Centers for Disease Control and Prevention estimates that about 3.2 million people in the United States have hepatitis C. But Bruce Burkett, Founder and Director of the Hep C Alliance, said the disease often goes untreated simply because people don’t know they are infected.
“Someone can have it for decades before they have any symptoms. It's a very silent disease,” Burkett said.
According to the CDC, most people with chronic hepatitis C do not have any symptoms until their liver is already damaged. Burkett was diagnosed with the virus in 1989, but because treatment for the disease was so new it took until 1997 before he was cured. This was the case for many people with hepatitis C until the Food and Drug Administration approved a new drug called Sovaldi in 2013.
Dr. Stefan Sarafianos with the MU School of Medicine said Sovaldi was revolutionary because it directly targeted the virus and had more than a 90 percent cure rate when taken together with the previous hepatitis C drugs. After Sovaldi was approved, several other pharmaceutical companies joined the race to find their own best treatment.
“There's an incredible competition and progress into getting additional combinations and of course this affects the patients in more than one way," Sarafianos said. "Not only are these good therapies that could lead to eradication but they're also effecting the accessibility and then the price of each one of these therapies.”
And the price is a big concern when it comes to treating hepatitis C. When Sovaldi was first introduced in 2013, it cost $84,000 for the 12-week treatment, in addition to costs for other necessary injections. When pharmaceutical company AbbVie introduced its new drug Viekira last December, which doesn’t require additional medications, it set the price at $83,000.
These may seem like astronomical numbers, but Sarafianos said he doesn't expect the cost of treatment to remain this high for patients with hepatitis C.
"Part of the high prices is that the companies, they're trying to get their investment and make the profit during the time when their patents are protected," Sarafianos said. "But after awhile, these drugs will be made by other companies for much cheaper and then the price will fall dramatically."
Although it varies, Sarafianos said most patents for prescription drugs last about 10 years. Even with the high prices, the cost for hepatitis C treatment might not be a bad deal for insurance companies.
“The cost of the liver transplant is much more than that so if you can treat a patient and cure them then the cost of the liver transplant will not be there,” Sarafianos said.
And Missouri’s new agreement with AbbVie will bring the price down even more. Last month, Missouri announced it would be switching to Viekira for Medicaid patients with hepatitis C. According to a press release, Missouri negotiated a rebate for treatment of Medicaid patients together with a “25-state purchasing consortium.” The Department of Social Services declined to give more information about the consortium or the agreement with AbbVie, but the press release estimates that the rebate will reduce the cost of treatment by 30 percent, saving the state over $4 million next year.
But as Burkett points out, not all Missourians with hepatitis C will benefit from the Department of Social Service’s agreement.
“You have stage 3 or stage 4 liver disease, stage 4 is cirrhosis, you have to be drug and alcohol free for at least six months," Burkett said. "The biggest problem is getting on Medicaid period.”
Sarafianos said these treatments are so new that doctors and other parties haven’t had to time to determine when patients with hepatits C should receive treatment.
“We are at the stage that everybody is learning right now," Sarafianos said. "The medical doctors will have to figure out what is the optimal time to start the therapy and then others will have to weigh in and consider who should be eligible and when.”