Hepatitis C is a liver infection that can lead to serious and life threatening complications if left untreated.Direct-acting antiviral medications can effectively cure hepatitis C by eliminating the virus from the body.Despite there being a cure, the high cost of treatment remains a barrier to care.
Hepatitis C is a liver infection caused by the hepatitis C virus (HCV). Over the years, researchers have made many advances in hepatitis C care and treatment. Today, there are several effective medications that can cure hepatitis C in most people.
Direct-acting antivirals (DAAs) are typically taken for 8 to 12 weeks. The medications stop the hepatitis C virus from multiplying in the body and can prevent long-term complications like liver damage.At first, this sounds like great news. An effective medication, taken for as short as 8 weeks, and hepatitis C can be cured.But even though these treatments are available, not everyone is able to access them.
DAA medications are expensive. The United States does not have universal coverage for hepatitis C treatment. For people without drug coverage, the cost can prevent them from getting treatment. And even for those with private insurance, the cost can still be high.
Many people also have other barriers to treatment. Stigma and lack of access to healthcare can make it difficult to get the right care. Without the right treatment, liver damage from hepatitis C can even lead to death.
Nearly 2.4 millionTrusted Source people in the United States were estimated to be living with chronic hepatitis C in 2016. On top of that, many people with hepatitis C may not know they have it. Some people don’t experience symptoms until permanent liver damage occurs.
Complications from hepatitis C are preventable with the right treatment. Keep reading to learn how the cost of hepatitis C treatment creates barriers to care, and what needs to be done to ensure everyone has access to a cure.
Costs of hepatitis C treatment and care
Antiviral medications, such as DAAs, can cure hepatitis C. Most of these medications have been approved by the Food and Drug Administration (FDA) within the last 10 years.Sofosbuvir (Sovaldi) is a DAA that received a lot of attention when it first came out in 2013. Each tablet cost $1,000, meaning the total cost of 12 weeks of treatment was around $84,000Trusted Source. The cost to treat everyone in the United States with chronic hepatitis C would be $310 billionTrusted Source.
Since 2013, other DAAs for hepatitis C have come on the market, which has started to push down their price. There are also some generic versions available that cost much less. One drug company released a generic version of their DAA in January 2019 with a cost of $24,000 for treatment. There are ongoing discussions that the costs of generic DAAs could be even further reduced.
Still, treatment for hepatitis C isn’t just one appointment. Regular monitoring, liver scans, and blood work are recommended throughout treatment — which can cost hundreds more. These tests are done to ensure medications are working to reduce the viral load, which gives more information about how much hepatitis C is still in the body.
People with hepatitis C may also get care from a doctor who specializes in digestion, liver health, or infectious disease. This level of specialized physician care is not always available, and the cost to see a specialist can vary, averaging around $200–$300 or higher.
Even people with private drug insurance are not always able to access treatment. A 2019 study looked at insurance claims for hepatitis C treatment. Only 690 claims — 46 percent — of the 1,501 submitted were approved. An additional 53 claims were approved after appeals were made. This still leaves many people stuck paying out of pocket.
There may be restrictions that prevent getting the cost covered. Sometimes, the claim is declined if a person is still using alcohol or drugs. Other times, it’s because liver damage isn’t at an advanced stage.
Effects on certain populations
Some groups of people are at a greater risk of contracting hepatitis C. A 2021 review identified three groups most at risk in high-income countries:
people who inject drugs
men who have sex with men (MSM), especially those who also have HIV
It is estimated that 80 percent of hepatitis C infections are linked to use of injected drugs. Due to ongoing effects of trauma from colonization, Indigenous people are at greater risk of drug use.These same groups often encounter additional challenges trying to access healthcare. Transportation, stigma, and lack of culturally competent care are ongoing barriers.
While the rise of generic drugs and greater competition in the market has reduced the actual costs of DAAs, perceptions about the high cost remain. There can be hesitancy to prescribe them if there is a feeling that the cost might not be “worth it.” For example, some healthcare providers may have concerns that the person with hepatitis C would not be able to adhere to treatment.
That same 2021 review showed that some providers don’t want to treat someone who is actively using drugs. On the other hand, some people who inject drugs think programs will only cover treatment once. They may worry about remaining sober and not being eligible for future treatment. These beliefs prevent some people from reaching out for treatment.
Progress and goals
Hepatitis C is recognized as a worldwide public health problem. By 2030, the World Health Organization (WHO) is making it a priority to reduce new hepatitis C infections by 90 percentTrusted Source and reduce deaths from the virus by 65 percent.
One idea is to create a program similar to the AIDS Drugs Assistance Program (ADAP). ADAP is available in every U.S. state and territory. Funding comes from the federal government to support low-income people living with HIV. This means that the cost of HIV treatment is no longer a barrier to getting the right care. A similar program for people with hepatitis C would eliminate the cost barrier.
Researchers are also exploring whether everyone with hepatitis C needs to see a specialist, which can increase wait times and cost. In a 2017 trialTrusted Source, researchers in the District of Columbia explored whether a community-based model could work. Primary care physicians and nurse practitioners were trained to provide DAA treatment. Some individuals were seen by these trained providers, and others saw a specialist.
They found that cure rates were the same across all groups and there were no adverse effects. Providing care in a community setting can increase access and decrease costs of care.
Medicaid also released a report in early 2021 showing several improvements in access to hepatitis C care. In 2014, many states were unclear about who qualified for treatment through Medicare. Several states had rules that people needed to have serious liver damage before Medicaid would pay. By 2017, 32 states had changed those rules. These changes mean that a person can access treatment before liver damage occurs or at an earlier stage.
The same Medicaid report also shows that several states have changed sobriety rules. In 2014, 28 states had rules that a person needed to be sober for a certain amount of time before getting treatment. Now, in 2021, 74 percent of state Medicaid programs have no rules about sobriety. This greatly reduces discrimination against people who inject drugs.
There have also been challenges with who was allowed to prescribe DAA medications. As of May 2021, most states will allow hepatitis C treatment to be prescribed outside of a specialist. Sixteen states permit treatment if done in consultation with a specialist. Only two states — Arkansas and New Jersey — still require that a specialist is the one who prescribes treatment.
Hepatitis C can lead to complications such as liver damage, but it is highly treatable. DAAs are a relatively new class of medications that can cure hepatitis C in most people. But the high cost of treatment is a barrier for many to get the care they need.
While there have been some advances in access to care, more can be done. Many U.S. states have increased access by changing their Medicare policies. There is also a move towards more community-based care to avoid the wait and cost of working with a specialist. With these changes, it’s possible that new infections and deaths can be greatly reduced — and potentially eliminated — in the years to come.