For many illnesses, the diagnostic process is both linear and easy; the person feels or sees symptoms of a problem, they visit their hospital or clinic for a test, the test comes back positive for the illness, they receive medication, and they are cured. For hepatitis C, however, the process is often very different. First, many people do not experience symptoms after being infected with the virus, so they may not know for months or even years that they have it. Next, when the patient is tested (either by requesting a test or via general bloodwork that shows exposure to the virus), the test is a multi-part test. First, there is a test for exposure, whether the person has come into contact with the virus. Next, a person who tests positive is tested to find out if the virus is within their body. If that test is positive, they are tested to find out what genotype of the virus they have. Each of these tests can be considered expensive, as it requires each step before treatment can begin.
Why Is Treating Hepatitis C So Expensive?
Once a person tests positive for exposure, for having the virus within their body, and the genotype is known, the medication plan can begin. The costs of many of these drugs can be more than $100,000USD. This is because drug companies have a monopoly on producing their drugs for a set period of time after the drug is approved for use by the American government agency’s Federal Drug Administration (FDA). In order for pharmaceutical companies to invest the time and money into researching, creating, and testing a drug, they need to be financially incentivized. In America, the incentive is that, when the drug is approved, their company is the only one permitted to make, market, and sell the drug for a period of time. This means that drug companies create drugs for hepatitis C treatment with the goal of making their investment back and making profit, especially during the time when they are the only place a patient can obtain the drugs. However, during this time, the company wants to make as much profit as possible and they know the patient has no alternative option to obtain that drug, which often leads the prices to be very high. After the drug company’s monopoly on the drug ends, generic forms of the medication can be made, which typically lowers the pricing as the market for the drug becomes competitive. However, by this time, there may already be a newer and better drug on the market which is under the monopoly rules. This often means that only the wealthiest patients have access to the latest and best drugs and others are forced to use drugs that are based on price, rather than efficacy or risks of side effects. In some cases, the patients with the lowest incomes cannot even afford the generic version of drugs and the virus continues to replicate in their body and causes additional damage before the patient finds a way to pay for the medication and rid their body of the virus.
What Would Happen If Everyone With Hepatitis C On Medicaid Were Treated?
Currently, too many people with low incomes are forced to endure drugs with lower efficacy rates and higher instances of side effects, if they are able to afford the drugs at all. Medicaid is a medical program for those with very low income levels. Often, those on Medicaid are given limited numbers of options for drug approvals. This can mean that a person suffering from hepatitis C may not be treated with drugs right away, if the Medicaid approval team finds the drugs to be either too expensive or considered not mandatory for the patient, if the patient is showing minor or no symptoms. In some cases, this means that the doctor and patient have to wait for the virus to replicate and cause significant damage before the doctor can convince Medicaid that there is substantial damage occurring and thus the patient’s life is at risk without the drugs. If everyone with hepatitis C on Medicaid was treated as quickly as possible, this situation would not occur. Instead, the patient would receive immediate treatment, which would minimize the damage to the body as quickly as possible. This would lead to more cases of cured patients and fewer situations in which permanent damage occurs. As the permanent damage can lead to the inability to work, which keeps the person and their family on government assistance programs indefinitely, as the lack of income does not allow the person or their family to become self-sufficient. In addition, a lack of treatment until the damage is severe risks the necessity for the patient to be on medications forever or even to receive an organ transplant, which would be an expensive cost to the Medicaid program. Minimizing these long-term or permanent problems can save Medicaid millions or even billions of dollars.
How Can I Help Change The Way Things Are Currently Done?
If you are interested in helping to change the way the Medicaid system currently works, you can reach out to your local politicians to encourage them to keep your feelings in mind when they vote on Medicaid bills or on how budgets plan for the treatment of those with little to no income. You can also reach out to your local hospital or clinic to ask how they are working to change the system and you can offer to aid them in their process.1-10
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Graham, J. (2016). Medicaid, Private Insurers Begin To Lift Curbs On Pricey Hepatitis C Drugs. Kaiser Health News. Retrieved 24 August 2016, from http://khn.org/news/medicaid-private-insurers-begin-to-lift-curbs-on-pricey-hepatitis-c-drugs/
Harper, J. (2016). States Deny Pricey Hepatitis C Drugs To Most Medicaid Patients. NPR.org. Retrieved 24 August 2016, from http://www.npr.org/sections/health-shots/2015/12/27/460086615/states-deny-pricey-hepatitis-c-drugs-to-most-medicaid-patients
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Taylor, E. (2016). Denying Medicaid Patients Access to Hep C Treatments is Wrong and Illegal. The Huffington Post. Retrieved 24 August 2016, from http://www.huffingtonpost.com/elizabeth-g-taylor/denying-medicaid-patients_b_10358766.html
Twedt, S. (2016). State Medicaid program wrestles with high cost of hepatitis C treatment. Pittsburgh Post-Gazette. Retrieved 24 August 2016, from http://www.post-gazette.com/business/healthcare-business/2016/05/31/Pennsylvania-Medicaid-program-wrestles-with-high-cost-of-hepatitis-C-treatment/stories/201605290094