What The Hepatitis C Crisis Says About The U.S. Healthcare System

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There has been a cure for Hepatitis C since 2014, yet nearly 4 million Americans are living with the viral infection, according to American Liver Foundation.

The treatment involves taking an oral pill for eight to 12 weeks, once a day. It has minimal side effects including headache, nausea, fatigue and itchy skin. The cure rate is nearly 98%, according to research published in the Journal of Hepatology.

Importantly, this breakthrough in medicine has led to about 1 million Americans being cured of Hepatitis C, according to Dr. Francis Collins, previous director of the National Institute of Health from 2009 to 2021. Despite this, up to 3.9 million Americans are living with this infection, with almost 75% of them unaware they have Hepatitis C.

The natural question is why? Why are so many Americans living with an infection that has an effective outright cure? It’s an important question given Hepatitis C is the leading cause of liver cancer, leads to scarring of the liver and claims the lives of almost 15,000 Americans each year.

According to Dr. Francis Collins in his New York Times article, “the cost of curative medications remains stubbornly high, so many insurance companies and Medicaid programs have erected barriers to coverage, requiring, for instance, abstinence from drugs and alcohol before people can receive treatment, referral to a specialist, or that the patient already shows liver scarring. Relatively few doctors offer treatment, and many sites where people at risk come for care do not even offer testing, let alone the cure. The result is that fewer than one in three people diagnosed with active infection get timely treatment.”

The crisis surrounding Hepatitis C highlights a multitude of challenges with the healthcare system in America. First, important life-saving medications are often costly and unaffordable for those who need it most. The list price for a monthly supply for the oral pill that can cure Hepatitis C is over $13,000.

This astronomical price restricts many Americans from receiving a treatment that could be the difference between their life and death. This comes as no surprise, as 58 million Americans experience medication insecurity, or the inability to pay for a medication at least once in the last 12 months, according to a Gallup report published by Senator Chuck Grassley.

In addition, administrative complexity of insurance policies also acts as a real barrier for people to receive important treatments. As Dr. Collins points out, getting the drug to treat Hepatitis C is not straightforward. Patients often have to juggle many hurdles, such as getting imaging to confirm certain findings or refraining from drugs and alcohol. This can be extremely challenging given the rise of Hepatitis C infections from the opioid crisis, as sharing needles remains an important cause of transmission of the disease. New cases of Hepatitis C more than tripled from 2010 to 2016 due to the opioid crisis, according to CDC reports.

Insurance providers may be reluctant to commit resources to life-saving treatments for those engaging in life-threatening behavior. However, expecting people to abstain from drugs before offering a life-saving treatment would prevent countless Americans from an impactful treatment.

Finally, access to appropriate care, testing and treatment can exacerbate health disparities and inequities. Although more data is needed to fully understand what percentage of health facilities offer testing and treatment for Hepatitis C, Dr. Collins acknowledges that many healthcare sites do not offer such services for those in need, particularly resource-limited areas such as rural areas. This means many Americans will not even know they have Hepatitis C, and many also will not benefit from the medicine that can prevent illness, cancer and ultimately death. As many as nearly 3 million Americans are unaware they have Hepatitis C, according to the American Liver Foundation. This invariably will have a profound effect on low-income and rural communities, which often have limited access to healthcare facilities.

Despite these challenges, there is good news. President Biden outlined a five-year program to eliminate Hepatitis C, which would include broad access to curative medicines, free access of these medicines to those most in need and more point-of-care tests to allow for more rapid and widespread testing.

Whether or not Congress will approve this program remains to be seen. Some countries have demonstrated a real commitment to ending Hepatitis C. Australia, for example, introduced unrestricted access to curative antiviral medicines for the general population.

The Hepatitis C crisis personifies many of the problems the American healthcare system faces, and these issues must be addressed for Americans to live healthier.

The United States, as a global superpower, should take the lead in initiating pro-active measures in ending and preventing Hepatitis C as opposed to implementing reactionary measures in addressing a crisis that continues to grow.

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