Insurance company's action could mean big things for Hepatitis C sufferers

By JoAnn Seltzer | Jan 11, 2017

SAN FRANCISCO — More patients will have access to a life-saving medicine after a decision was made recently by a large insurer.

According to Modern Healthcare, Blue Shield Life and Health and Blue Shield of California was facing a class-action suit in Northern California after it initially denied a costly Hepatitis C medicine to some patients. The lawsuit was dismissed by a federal judge last week after Blue Shield decided to expand coverage on the drug Harvoni. Previously, the company only covered the medicine for the sickest patients.

Ryan Clary, executive director of The National Viral Hepatitis Roundtable, told The Northern California Record he believes everyone who has Hepatitis C who wants to be cured and has insurance and a provider willing to treat them should have access to the medicine.

“Most people would like to be cured of an infection, that's a chronic, often life-threatening disease, before severe health complications arise,” he said. “Being able to get rid of the anxiety of having a very severe virus that attacks the liver is, for us, reason enough.”

Hepatitis C can lead to a lot of complications from fatigue and muscle pain to liver disease. It's also the leading cause of liver cancer, Clary said. The effects of the disease vary from person to person.

In addition to healing the sick, providing access to this class of medicine can prevent the spread of it, he said.

Clary added that a person living with Hepatitis C may not be suffering from liver disease, but may continue engaging in risky behavior putting other people at risk, he said. If the person is cured they will no longer be infecting others.

Hepatitis C currently kills more people than any other infectious disease in the United States including HIV, Clary said.

“We have the opportunity to actually eliminate Hepatitis C in the United States. The tools are out there,” he said. “It's a serious public-health threat.”

Prior to Harvoni and other drugs in its class, patients had to use a drug that needed to be injected by the patient for 48 weeks. Severe side effects, similar to chemotherapy, prevented many from even finishing the treatment, he said.

Reservations about making it available to all insured patients is probably a combination of two factors, Clary said. The course of treatment needed can cost $100,000. Plus, there is a stigma attached to Hepatitis C in some cases.

Clary said one way it can be spread is by the sharing of needles and the current opioid epidemic in California and the nation has helped to spread the disease.

It's unfortunate that patients have to sue to get access to treatment, Clary said, but he is hopeful that cases like this will mean insurance companies will be less inclined to put such strict restrictions on life-saving medicine in the future.

“I can't think of any other health condition where you would tell somebody we're going to wait until you get really sick before we treat you or in this case cure you. It just doesn't make any sense,” he said.

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