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$1,000 a pill: Ohio Medicaid lifts restrictions on costly hep C drugs

As the opioid crisis led to a spike in new hepatitis C cases, a breakthrough prescription hit the market five years ago that could cure the viral liver disease — but at an eyepopping price tag of $1,000 per pill.

Now, as costs are coming down and demands for compassion mount, Ohio Medicaid will let all patients get the potentially life-saving medication once diagnosed instead of providing them to only the sickest patients.

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“We have been studying this issue for some time and believe this action is the next appropriate step as part of Ohio’s response to the opioid crisis,” stated Tom Betti, spokesman for Ohio Medicaid.

Nearly 22,000 Ohioans were newly diagnosed with hepatitis C in 2017, up 119 percent from 2013, according to the Ohio Department of Health.

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Several medications have been introduced to battle the uptick. Sovaldi was approved for sale in 2013 for $1,000 per pill wholesale, or $84,000 a course. Next came Harvoni in 2014 for more than $1,300 wholesale per pill, or $94,500 a course. Last year, a competitor named Mavyret was introduced for a relatively cheaper $26,400 per course of treatment.

The expensive medications caused Medicaid and private insurers that manage Medicaid plans to consider whether to limit the treatment based on the patient’s stage of liver damage, and many did.

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But Ohio Medicaid announced late Wednesday that in an effort to mitigate the harm caused by the opioid epidemic, the department is changing policy starting Jan. 1 to begin treatment at the time of chronic hep C diagnosis.

The opioid crisis has led to more hep C cases and driven increased demand for treatment, with shared needles being one of the ways the virus spreads.

Highly effective but highly expensive drugs to treat hep C hit the market around when the opioid crisis began to drive increased cases of the viral liver disease, and many states rationed access to these pricey medications.

These prescriptions should have never been rationed in the first place, according to Rebecca Steinhauser, managing attorney for health care and public benefits at Advocates for Basic Legal Equity, which represents low-income clients.

Her firm maintains that restricting access to these medications violated Medicaid’s requirement to provide all necessary care. Clients would have symptoms like serious joint pain and exhaustion before liver damage reaches the point of meeting Ohio Medicaid’s previous standards.

“You wouldn’t ration care for a person with cancer and tell them you have to be at stage four before we are going to treat your cancer,” Steinhauser said.

Steinhauser said she was glad to learn Ohio Medicaid eased access voluntarily, unlike some states that changed policies after lawsuits.

“That is a very positive change. We’ve been advocating for that for two years now,” Steinhauser said.

She said one client in Athens drives 45 minutes one way every day to his job and can only manage to work part time because of his hep C but doesn’t have an advanced stage of the disease that would qualify him for the medications.

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“He was very concerned he wouldn’t be able to continue working because of the hepatitis C symptoms,” she said.

Another client in Lima had to stop working as a waitress and because of her positive hep C she can’t get surgery to repair hand and foot problems, yet doesn’t qualify for the new drugs. Her family is living off the income of her daughter who is 21.

Ohio Medicaid’s hep C policy is for the the family of drugs known as direct acting antivirals, like Sovaldi and Harvoni.

Hepatitis C direct acting antivirals drugs were a medical breakthrough for generally curing hep C in a couple of months. Earlier treatments lasted nearly a year with more side effects and less than half the cure rate of the new drugs.

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But the new drugs were among the most expensive in the U.S., even with negotiated discounts. Sovaldi was introduced with a $84,000 wholesale cost for a course of treatment. Its successor, Harvoni, was introduced in 2014 and cost $94,500 for a course of treatment. The final costs that private Medicaid plans pay are cheaper than the sticker price after rebates and negotiated discounts.

People with hep C are disproportionately low income and more likely to be incarcerated, so the expense of the drugs fell heavily on state budgets.

Gilead, which makes of Harvoni and Sovaldi, was widely condemned by patients, advocacy groups and some members of Congress its prices.

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Washington Medicaid was ordered in 2016 by a federal judge to cover all hep C patients, not just the sickest ones. North Carolina, Florida, New York and Delaware Medicaid programs are among states that expanded access in recent years.

At the same time that patients and advocacy groups called for more access to the life-saving medicines, lower-cost options were introduced Those included drug maker AbbVie’s Mavyret, approved in 2017, which has a comparatively cheaper price of $26,400 for a regimen.

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Betti said competition among manufacturers, enhanced rebates, and shortened duration of treatment has resulted in significant decrease in total cost.

The issue of hep C drugs also underscores the reality that Medicaid is the primary source of coverage for people with addiction issues, said Loren Anthes, Medicaid researcher with Cleveland-based Center for Community Solutions. He said part of the context is remembering access to Medicaid also means access to addiction treatment and prevention that can stop the spread of the opioid crisis.

“It’s important that people understand the preventative access is dependent on Medicaid coverage,” Anthes said.

Associated Press contributed to this report.

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