Special Issue of AJMC Examines Policy Questions Surrounding Hepatitis C Treatment

The arrival of direct-acting antivirals to treat hepatitis C virus raised unprecedented policy questions in healthcare. This new drug class was initially met with alarm over cost and barriers to the cure, despite the potential for long-term savings, and represents one of a number of topics explored in a special issue of The American Journal of Managed Care.


PLAINSBORO, N.J.—Few events in healthcare changed the landscape like the December 2013 arrival of Sovaldi, which made headlines mostly for its cost despite its potential to wipe out a silent killer, hepatitis C virus.

Since then, policy and moral questions surrounding the drug—part of a class called direct-acting antivirals (DAAs)—have created fallout in the courts and state governments. Advocates assert that patients should not be denied therapy that offers not only immediate health benefits but also long-term savings, as patients avoid cancer and liver transplants.

In New York State, officials recently used the threat of legal action to force seven major commercial insurers to pay for DAA treatment. But as The American Journal of Managed Care discusses in a new special issue, thousands with hepatitis C virus are denied access to therapy, which advocates say is short-sighted and risks lives. The full issue is available here.

Led by a letter from guest editor Jay Bhattacharya, MD, PhD, on the “dismal arithmetic” of hepatitis C, this special issue adds to the growing body of new research that shows hepatitis C cures have the potential to provide substantial cost savings for both the public and private payers. Authors find that improving access will require more creative and effective policymaking, from more comprehensive screening through treatment.

“Although the medical prospects facing patients with hepatitis C virus have never been better, the prospect of gaining access to a cure is another matter for many patients,” writes Bhattacharya, of the Center for Primary Care and Outcomes Research at Stanford University School of Medicine.

Data released this week by the Centers for Disease Control and Prevention (CDC) show that acute cases of hepatitis C virus doubled between 2010 and 2014, and the number of deaths attributable to the disease reached an all-time high in 2014 at 19,659—despite the fact that screening and cures are available.

While there has been considerable attention on commercial insurers, this special issue discusses the effect of hepatitis C spending on Medicare Part D, as well as the effects of rationing treatment on the Medicaid population. Multiple papers document—and calculate—direct and indirect benefits that would result from universal coverage for DAA treatment.

The problem, as Bhattacharya points out, “is that the price of DAA treatment is so high.” With a list price of $84,000 for a course of Sovaldi and an estimated 2.7 million people in the United States with chronic hepatitis C, the initial cost of care has received more attention than long-term savings. Bhattacharya discusses potential solutions to the pricing problem, and acknowledges pitfalls.

Brian Haug, president of Pharmacy, Managed Markets, and Rare Disease, and publisher of The American Journal of Managed Care, praised the outstanding quality and timeliness of the special issue.

“The impact that hepatitis C therapy has had on managed care, and on healthcare more broadly, cannot be overstated,” Haug said. “We are pleased that The American Journal of Managed Care is the source of important new evidence at this critical time, when payers need facts to make decisions.’’

About the Journals and AJMC.com

The American Journal of Managed Care is the leading peer-reviewed journal dedicated to issues in managed care. AJMC.com distributes healthcare news to leading stakeholders across a variety of platforms. Other titles in the franchise include The American Journal of Accountable Care, which publishes research and commentary on innovative healthcare delivery models facilitated by the 2010 Affordable Care Act. AJMC’s Evidence-Based series brings together stakeholder views from payers, providers, policymakers and pharmaceutical leaders in oncology and diabetes management. To order reprints of articles appearing in AJMC publications, please call (609) 716-7777, x 131.

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