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Hepatitis C patients may not qualify for pricey drugs unless illness is advanced
Washington Post

In the past year, new hepatitis C drugs that promise higher cure rates and fewer side effects have given hope to millions who are living with the disease. But many patients whose livers aren’t yet significantly damaged by the viral infection face a vexing reality: They’re not sick enough to qualify for insurance coverage for the drugs that could prevent them from getting sicker.

An estimated 3.2 million people in the United States have hepatitis C, according to the Centers for Disease Control and Prevention. Faced with a cost per patient of $95,000 or more for a 12-week course of treatment, many public and private insurers are restricting access to those whose liver damage is already serious. Other strategies that limit access include restricting who can prescribe the drugs and requiring early proof that the drug is working before continuing to pay for treatment. In addition, many state Medicaid programs require that patients be drug- and alcohol-free for months, preventing further liver damage, before they can get one of the new hepatitis C drugs.

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