A state program that aims to make hepatitis C treatment affordable and accessible has garnered thousands of users and has inspired a similar federal program.
According to the Centers for Disease Control and Prevention, more than 2 million people in the United States have hepatitis C, and about 40% of people don’t even know they have it, leading to new infections. Hepatitis C is spread by through contact with blood from an infected person, according to the CDC, and most people who contract it do so from sharing needles or other equipment used for injecting drugs. The virus kills more than 15,000 people every year through complications like liver failure and liver cancer.
That was the case for William Glover-Bey, who was diagnosed with hepatitis C in 1992. It started with some itching, but 24 years later, his liver was plagued with cirrhosis.
“This is a silent killer,” explained Dr. Francis Collins, acting science adviser to President Joe Biden and the former director of the National Institutes of Health. “When you first get the virus, you may have five, 10, 15, 20 years of feeling pretty normal. Meanwhile, that virus is doing its damage.”
Breakthrough treatments mean the disease is curable, but the high price tag has prevented many from accessing it. Since 2013, oral antiviral drugs that can cure hepatitis C have been on the market. The drugs have few side effects and have a 98% cure rate, said Collins.
All it takes is one pill a day for 12 weeks — and tens of thousands of dollars.
“This is a health equity issue,” said Collins. “These are often people on Medicaid. They may be people who are uninsured.”
To try to make a difference, Collins approached Biden with a bold proposal: He wanted to eliminate hepatitis C in the United States by making those medications affordable and available to people in need.
“If we could get access to the drugs for people who are infected, we calculate in 10 years, you would save the federal government $13.3 billion in healthcare costs that we wouldn’t have to spend on liver transplants, liver cancer, liver cirrhosis,” Collins said. “You have saved billions of dollars and tens of thousands of lives. What’s not to love here?”
The administration agreed, and Dr. Collins is spearheading the federal effort from the White House. He pointed to an existing project in Louisiana, which uses a subscription model to limit costs. It allows the state to pay a flat fee to a drug company, receive an unlimited amount of medication, and “treat as many as you can,” said Republican Senator Bill Cassidy, a physician who has treated people with hepatitis C and who supports the Louisiana program.
The arrival of the coronavirus pandemic complicated things, but still, the number of people beginning treatment has increased dramatically. Now, more than 14,000 people have been treated through the Louisiana program.
“It’s possible that you can treat a lot more patients than you’ve previously treated if you take the cost of the medication, if you eliminate that as a barrier,” Cassidy said.
Biden has proposed spending $12.3 billion over the next 10 years to eliminate hepatitis C. Congressional support for the initiative will depend heavily on a pending analysis from the Budget Office. If the plan is funded by Congress, it would expand testing, broaden access to those powerful antiviral drugs, and boost awareness. Collins said this would save billions of dollars and tens of thousands of lives. Cassidy seemed optimistic that there would be support for the federal initiative.
“Good policy is good politics, but everybody in Congress knows somebody with hepatitis C,” Cassidy said. “If the administration comes up with a good plan and it can justify what it’s asking for, and we can show success elsewhere, I’d like to think that we can go to members of Congress and get buy in.”