Hepatitis C treatment is about to enter a new arena. I am obsessively checking my news feed for the FDA-approval announcement for the once-daily combination pill sofosbuvir/ledipasvir. Gilead’s European brand name for it, Harvoni, is expected to have the same name in the US, although frankly the name sounds like an espresso machine. With response rates hovering around 95%, and nearly 100% in some cases, this ought to be cause for celebration, EXCEPT…
Except for the fact that across the country, patients are being denied hepatitis C treatment. At least thirty states and some private insurance companies are only approving current hepatitis C drugs for patients who meet a long list of criteria. Typically, documentation is required showing that the patient has stage 3 or 4 fibrosis/cirrhosis (by either liver biopsy or non-invasive procedures) and a pattern of abstinence from drugs and alcohol in the past six months. Trace marijuana in screening results will get a denial. I don’t expect this to change when Harvoni is approved.
Do you know any other disease that requires patients to prove a pattern of abstinence from drug and alcohol in the past six months? This is just wrong. It is humiliating to be screened for drugs and alcohol. It’s discriminatory. It makes sense if you are driving erratically, but doesn’t make sense if you are trying to help people get well and prevent further spread of a viral infection.
Can you think of other diseases that wait until the patient is extremely ill before we treat them? What if we didn’t treat pre-diabetes? Can you imagine saying to someone, “We’ll approve treatment when you have nerve or retina damage. Then we will be sure you really have a serious problem. Granted, it will be too late to fix your blindness, but at least our budget is intact.”
That’s really what we are doing here by waiting. The biggest problem with using the presence of cirrhosis as a reason to treat is then you still have a patient with cirrhosis. The beauty of treating hepatitis C patients early in their disease is that the liver can regenerate, and you can avoid serious problems, such as hepatocellular carcinoma (HCC), the need for liver transplantation, and the most severe consequence of all—death. Yes, let’s not forget death. After all, death is the reason why the prevalence of hepatitis C in the US has dropped.
We need to speak out. We need every single voice, whether you are cured already, or know someone who has hepatitis C, or you want to see healthcare applied justly. You can help by participating in Project Inform’s I deserve a Hep C Cure campaign. For details, visit Project Inform’s website or facebook page.
The time to fight for justice is now. These words of Martin Luther King, Jr., spoken more than 40 years ago, have never been truer: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”