How Much Does Treatment for Hepatitis C Cost?

Overview

Hepatitis C is a viral infection that attacks the liver. Infection with hepatitis C can lead to serious liver disease, including cirrhosis and cancer. Hepatitis C virus (HCV) is transmitted by exposure to blood or other bodily fluids that contain HCV.

Approximately 3.5 million Americans have chronic hepatitis C. About 19,000 of these people die each year from cirrhosis or liver cancer.

Fortunately, recent advancements in the fight against this virus have changed the outlook for people with HCV. New drugs have transformed the disease from one that can, at best, be controlled to one that can be cured for most people who have it.

However, a downside to these successful drug development efforts is their hefty cost of treatment. Read on to learn how much these treatments can cost, what makes them so expensive, and how your treatment for HCV can be more affordable.

New lifesaving drugs

A few years ago, cure rates for the top-performing HCV drugs — interferons and ribavirin — were around 60 percent. Most of these medications had to be given by injection. Almost all of them had side effects so severe that some people abandoned the treatment.

The newer drugs available today cure up to 99 percent of people who take them, depending on the type of HCV infection and treatment exposure.

These new drugs are called direct-acting antivirals (DAAs). The U.S. Food and Drug Administration (FDA) approved the first of these medications for HCV treatment in 2011. Several more medications have been approved since that time.

Most of these individual drugs are effective for specific strains, or genotypes, of HCV. However, some newer combination medications, which contain two or more drugs, work for all genotypes.

DAAs may be used alone or, very often, in combination with other drugs. Most are available in pill form. Typically, these pills have far fewer side effects than previous treatment options.

Why the high costs?

At this time, there’s a short list of blockbuster HCV drugs. Because the FDA only recently approved these drugs, the companies that manufacture them have market exclusivity. That means only these companies can promote and sell the drugs. It also means there are no generic versions of these drugs yet. Generics are typically much cheaper than brand-name versions.

The FDA determines how long this period of exclusivity will last. During this time, the pharmaceutical companies have a lot of freedom in establishing prices. And those who developed the new HCV drugs have set the pricing bar high.

The table below highlights the average cost of treatment for the combination DAAs currently available. Most of these drugs take at least 12 weeks to cure HCV, while the most recently approved drug, Mavyret, can take only eight weeks.

These costs are averages derived from information provided by www.goodrx.com. They were current at the time this article was published.

Who’s paying?

Many people who require HCV medications get financial assistance from private insurance companies, insurance companies that administer state Medicaid and Medicare plans, and the Veterans Administration. These groups negotiate drug prices directly with the pharmaceutical manufacturers and don’t pay full price for the drugs.

While they help provide treatment for many, these groups have their own criteria for who receives treatment. These criteria may be based on:

• the severity of liver disease
• whether the person avoids alcohol and drug use
• whether the drug’s prescribed by a doctor who specializes in liver diseases
• the life expectancy of the person seeking treatment
• whether less expensive treatments could be used first
• the presence of other diseases that contribute to liver damage

Most insurers require pre-authorization for HCV treatments. The authorization process can be extensive. Essentially, you must be sick enough to meet the criteria established by your insurer. As a result, only a percentage of people who could be receiving these medications are getting them. However, with the new DAAs, coverage seems to be expanding.

Payment restrictionsBased on your insurance provider, some companies will only pay for treatment if you have cirrhosis of the liver or bridging fibrosis, which is a thickening and scarring of the liver.

Who can help me?

If you’re concerned about paying for HCV medications, remember that you aren’t alone as you seek treatment. There are people and organizations that can help you, including the following:

• Your doctor. They can help you by ordering and documenting the tests you’ll need so you can qualify to get your medications, especially if you’re working with a liver or infection specialist.
• Most drug manufacturers. There are patient assistance programs that offer free or reduced-cost medications for people who meet their criteria.
• Patient advocacy groups. These groups provide assistance with all aspects of HCV treatment. For instance, if your insurer denies treatment, you can appeal the decision with help from one of these groups. Your doctor can also help in this situation.

Where to find help paying for treatment

Drug companies and patient advocacy groups are a great place to start when looking for help paying for HCV medications. Here’s a list to get you started.

Manufacturers’ patient-assistance programs in the United States

• Gilead Sciences, Inc. can help with paying for Harvoni, Epclusa, and Vosevi.
• AbbVie Inc. can help with paying for Viekira Pak, Technivie, and Mavyret.
• Merck Sharp & Dohme Corp. can help with paying for Zepatier.

Patient advocacy resources

• The American Liver Foundation offers a free drug discount card that can significantly reduce the cost of medications.
• Help-4-Hep can provide information on financial help for testing and medications.
• HCV Advocate can connect you with a support group.
• The Partnership for Prescription Assistance helps qualified people get medication for free or at a very low cost.

The takeaway

Today there are several drug options available that can cure hepatitis C infection — that’s the great news. What’s less great is the high cost of these drugs. However, there are many options you can explore to find help paying for these medications.

The options listed in this article should help. But if you’re confused or have questions, be sure to talk to your doctor. They can point you in the right direction to help make sure you have access to these new lifesaving treatments.