One out of every 100 Americans is living with a deadly and communicable virus, yet most can't access the cure which will save their lives and halt the disease's lethal trajectory.
Hepatitis C now kills more Americans each year than HIV/AIDS and is 10 times more infectious. It has become a leading cause of liver failure and liver cancer -- the fastest-rising cause of all cancer-related deaths. For too long this blood-borne virus has silently ravaged communities across the country, often going unnoticed and untreated until it was too late. Until 2013, the only treatments for hepatitis C were painful and effective only half the time, leaving many patients with nowhere to turn, despite their diagnosis.
But now the tide is turning. Multiple treatments for hepatitis C currently offer cure rates of near 100 percent with minimal side effects. Now some of the biggest obstacles facing hepatitis C patients are health insurers.
Many private health plans and most Medicaid programs are requiring patients to first reach late-stage, often irreversible, liver disease before they can access effective treatment, and some are even denying access to many people with a history of substance abuse and to people living with HIV.
According to new research led by the Center for Health Law and Policy at Harvard Law School, 42 state Medicaid programs with stringent restrictions for hepatitis C treatment may even be violating federal Medicaid law, which requires states to cover drugs consistent with their FDA labels.
Access for privately insured Americans is similarly dismal, with many health plans imposing comparable restrictions and then requiring exorbitant copays that place a cure squarely out of reach for most patients.
A growing body of research is also proving that these restrictions will have costly ramifications for both patient health and the U.S. health care system, especially as the baby boomer population--which is most at-risk for hepatitis C--reaches Medicare eligibility.
A new Milliman study finds that connecting baby boomers with a cure would save 53,000 lives over the next decade and save taxpayers $4.5 billion as this demographic transitions to Medicare. It's also worth noting that the true impact of such treatment access is likely even bigger because while the study considered patients who are currently aware of their infection, a growing number of baby boomers are diagnosed each day.
Recent research also suggests that curing hepatitis C can yield cost savings for private insurers and Medicaid in the short-term by reducing the need for hospitalization, liver transplants and other costly procedures. A study funded by the National Institutes of Health finds that innovative treatments are cost effective in 83 percent of new patients and 81 percent of previously treated patients. And additional research published in Clinical Infectious Diseases suggests that immediately treating hepatitis C patients with new treatments is cost effective, even for those with only moderate disease progression.
By imposing discriminatory treatment restrictions, Medicaid and private insurers are not only putting the lives of millions of Americans at risk; they are also fanning the flames of a major public health threat while driving up long-term health care costs for themselves and for American taxpayers.
The reality is that hepatitis C is the only deadly disease for which curative treatment is widely withheld from patients. Imagine if an insurer mandated that a cancer patient reach metastatic levels before receiving chemotherapy, or that a diabetic lose a limb before being eligible for insulin treatment.
It's time to end this blatant unethical and short-sighted disease discrimination. It's time to cure hepatitis C.
Ryan Clary is the executive director of the National Viral Hepatitis Roundtable (NVHR), a coalition working to fight, and ultimately end, the hepatitis B and C epidemics in the United States.