Update: Hepatitis C in NYC and the Need for Expanded Access to Treatment
November 1, 2016
The New York City Department of Health recently released a report on Hepatitis B and C in New York City, including an annual 2015 report of Hepatitis C virus (HCV) rates. HCV is a blood-borne virus that can cause chronic liver disease, serious liver damage, and liver failure. The report shows that new cases of HCV in NYC have declined 4.7 percent from 2014 and also demonstrates the continued need for state spending on drugs that cure the virus.
HCV is a silent epidemic. People can be infected with HCV for decades without experiencing symptoms. Compared with other age groups, people born between 1945 and 1965 are four to five times more likely to be infected with HCV. An estimated 146,500 NYC residents over the age of 20, or 2.4 percent of the population, have HCV. The highest rate of newly reported HCV cases among people under 30 years old was found in the incarcerated population, which had a HCV rate of 169.2 per 100,000 people.
As many as 25 to 30 percent of people living with HIV are co-infected with HCV. Those who are co-infected often have a weaker immune response to HCV compared to those who aren’t co-infected. HIV co-infection more than triples a person’s risk for liver disease, liver failure, and liver-related death from HCV.
Until recently, HCV was an incurable chronic infection for most HIV-positive people. However, with newly developed medication – interferon (IFN)-free direct acting antiviral (DAA) regimens – a recent study found that 95 percent of co-infected patients can be cured of HCV.
Amida Care has covered treatment for hundreds of HIV-HCV co-infected members. Of those who have already completed the drug regimen, 400 (98 percent) have been cured of HCV. Amida Care’s ability to provide access to HCV medication and early treatment has helped hundreds of people improve their health and live their lives HCV-free.
Previously, New York State Medicaid covered Hepatitis C treatment only for those in advanced stages of liver disease or co-infected with HIV, but earlier this year, the state removed those restrictions. Several commercial insurance companies have lifted restrictions as well. 5,600 NYC Medicaid recipients received treatment for Hepatitis C in 2015—a 63 percent increase from 2014. The NYC Department of Health has administered screening tests, hosted educational trainings, supported syringe exchange services, and collaborated on other initiatives to decrease new HCV cases.
Unfortunately, the high price of HCV medications continues to create barriers to care for people who could be cured. From 1999 to 2014, HCV-related deaths in NYC increased by 38 percent. In 2013, the profit margin for pharmaceutical companies ranged from 10 percent to 42 percent, with an average of 18 percent —factoring in the cost of research and development, which pharmaceutical companies cite as an explanation for the high price of the medication. The most frequently used drug costs $1,000 per pill, upward of $70,000 per 12- to 24-week course of treatment, totaling an estimated $3.5 billion in sales from April to June 2015.
“Viral hepatitis cannot be eliminated as a public health threat without increased access to HCV treatment. If drug prices are lower, more people can access treatment and get well. Increased access means higher volume, which would in turn benefit pharmaceutical companies, and the upfront cost of HCV treatment also saves hundreds of thousands of dollars in long-term lifetime costs associated with infection,” said Terry Leach, Vice President of Pharmacy at Amida Care. “A cure exists for HCV. We can’t let cost barriers to accessing life-saving medication impose a death sentence. The time is now to expand access to all who need it.”