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discussion: medicaid paying for hep c Tx


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The least expensive 12 week tx for hep c is around $84,000. The patient population most at risk for having hep c is freqently covered by medicaid. currently some states allow medicaid to pay for hep c tx while others do not. opinions exist on both sides of this issue.

discuss.

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huge issue right now

 

cheapest treatment is down to about 36,000 which is not that far over the $20,000 for the interferon/ribavirin treatment

 

this is the worst case of profiteering I can remember a drug company doing, in collusion with other drug companies

 

Know how they priced this drug?  figured the cost savings to the entire system by treating, then made the cost of the drug a little bit less, so they say it "saves money" gross price manipulation......  gouging the consumer at the expense of profit taking....

 

US congress opened an investigation when they announced pricing info, then the national agency ASLD and others, recommended EVERYONE get treated (hello can you say they paid off the "expert boards") and now the patients are totally in a bind in that the insurance companies are saying they will not pay and making patients jump through hoop after hoop.

 

Oh yeah and the EXACT same treatment costs under $1000 TOTAL in Egypt....  Literally would be A LOT cheaper to fly someone to egypt and have them buy the drug!

 

Guidelines were just changed a week or two ago to state that the a fibrosure value of >0.48 requires treatment, otherwise now

 

 

 

 

This is simply a case of capitalism gone wrong - this would be fixable by allowing medicare to negotiate with drug companies for part D benefits so that there was a HUGE vendor that could demand deep discounts or you don't get on formula.... 

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If the cost savings favor the drug in the long run - I cannot cite facts but believe they do - then yes. Especially when you consider that it is a communicable disease. 84k is easily under the annual hospital bill of some of our liver patients.

 

Eventually the drug will become affordable. Yes it is unethical to charge this much. But one may argue that motivates the chemists to make these drugs.

 

The other sticky issue is what about the alcoholics? Do they get treated even if they seem likely to progress to EtOH cirrhosis?

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If the cost savings favor the drug in the long run - I cannot cite facts but believe they do - then yes. Especially when you consider that it is a communicable disease. 84k is easily under the annual hospital bill of some of our liver patients.

 

Eventually the drug will become affordable. Yes it is unethical to charge this much. But one may argue that motivates the chemists to make these drugs.

 

The other sticky issue is what about the alcoholics? Do they get treated even if they seem likely to progress to EtOH cirrhosis?

cirrhosis isn't contagious....

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Right.  I am just speaking theoretically, just like ETOH cirrhosis with ongoing drinking cannot get a transplant, I can see insurance denying hep c treatment for drinkers, saying that they have too high a chance of progressing to cirrhosis through another pathway that the treatment should be given to someone else instead.  Same can be true for those with ongoing IVDA.  Of course I do not think even insurance can address the third main mode of transmission (not talking transfusions here).

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