Patients with the hepatitis C virus who are on Medicaid in Oregon can expect to receive curative treatment in 2019, without having to wait for liver damage to set in.
In Oregon, patients with hepatitis C virus who are on Medicaid can expect to receive curative treatment in 2019 without having to wait for liver damage to set in. Despite having the highest rate of hepatitis C virus mortality in the country, per capita, Oregon’s Medicaid program had been rationing the drugs, which cost thousands of dollars.
About 100,000 Oregonians have been infected with the virus and more than 500 die every year, according to PBS. The Oregon Health Authority estimates that about half of those individuals who are infected don’t know it.
The problem was made worse by opioid use disorder, which led to a 20% rise in new infections from 2015 to 2016.
About a quarter of the state’s population is covered by the Oregon Health Plan. The state plans to end the rationing in March 2019, allowing the treatment before patients sustain liver damage.
Providing the drug to everyone infected with hepatitis C would have likely bankrupted the Oregon Health Plan and led to unaffordable premiums, health officials told the Associated Press (AP).
“It was a complete bank-breaker. There was no way individual insurance plans or governments could afford the pill where it was priced,” Jennifer Lind, CEO of Jackson Care Connect, a provider of Oregon Health Plan coverage said.
Pharmaceutical company Gilead Sciences had charged $84,000 for a 12-week treatment of Sovaldi, and it priced another drug, Harvoni, at $94,500. However, Gilead will release a generic version of Harvoni in January 2019, pricing it at $24,000.
Falling prices due to generics will allow more people to get treatment, Josh Balloch, vice president of government affairs for AllCare Health, another provider of Oregon Health Plan coverage added in the statement to AP.
Last year, investigators on a study published in The American Journal of Managed Care® called for a national strategy to eradicate hepatitis C virus from the United States, regardless of payer status.
The investigators found that restricting hepatitis C virus treatment for Medicaid beneficiaries based on one’s state of residence was flawed, and led to suboptimal treatment outcomes, high patient burden, and excess costs. It also worsened health disparities.
Sustained virologic response rates were 95.9% when everyone is treated, compared with 75.2% under Medicaid restrictions, and there were improved clinical outcomes, including:
Treating everyone, without restriction, would lead to a $3.8 billion overall savings in health care costs, according to the study authors.
An earlier version of this article appeared as, “Oregon Medicaid Program to End HCV Treatment Rationing in 2019,” on AJMC.com.