Health plan tiers raise drug costs for hepatitis patients

This is important information to think about if you have open enrollment.  Jacques Chambers article "Open Enrollment" will be featured in the next issue of the October Mid-Monthly HCV Advocate Newsletter - Alan

By Bob Herman  | October 5, 2015

A new report says that health insurance companies discriminate against people with hepatitis B and C by charging high out-of-pocket costs for drugs, but the industry lobby has called the analysis “very one-sided” and limited in scope.

The Affordable Care Act prohibits health insurers from discriminating against people on the basis of age, gender or health conditions, and the federal government has already made it clear it will monitor health plans sold on the public exchanges to ensure they meet ACA standards.

The not-for-profit AIDS Institute examined silver-level health plans that were sold on Florida's insurance marketplace in 2015. The group found that eight of the 12 insurers that sold 2015 plans had what it deemed as discriminatory practices for hepatitis B and C drugs. For example, Aetna placed many of its hepatitis drugs on the most expensive tiers with coinsurance rates up to 50%. Humana had a $1,500 prescription drug deductible and also had many of its hepatitis drugs on the highest tiers with large cost-sharing, the report found.

Read more....

The True Cost of an Expensive Medication

It was supposed to be a miracle, but now it’s what keeps Laura Bush, a nurse-practitioner near Albuquerque, awake at night.

There’s a drug called Sovaldi that works astonishingly well to cure people with the liver disease Hepatitis C. The rub? It costs $1,000 per day for all 12 weeks of treatment.

Bush’s clinic, First Choice Community Healthcare, is a federally qualified health center in the rural town of Los Lunas, New Mexico, which means she sees a disproportionate number of patients who are uninsured, underinsured, and on Medicaid, the government insurance program for the poor. In other words, they can’t afford Sovaldi.

Read more....

Study tallies huge cost of hepatitis C drugs for RI prisons

A new study finds that effective new hepatitis C drugs are so expensive the state of Rhode Island would have to spend almost twice its entire prison health budget to treat all its chronically infected inmates. Even providing the medicine only to the very sickest inmates who will remain in custody for at least another year would exceed the state prison system's pharmacy budget more than five times over.

The budget impact analysis, published online in the Journal of Urban Health, provides detailed new evidence of the "sticker shock" that states face in battling an epidemic that affects millions of people nationwide. The prevalence of the liver disease, which is often spread via injection drug use, is especially high in prisons. Meanwhile, the U.S. Supreme Court has obliged prison systems to provide inmates with care comparable to what is available in the community.

"The big problem is, even if you just take the most advanced disease, you can't afford it with the current correctional budget," said Dr. Brian Montague, assistant professor medicine and public health at Brown University and a physician in the Division of Infectious Diseases at The Miriam Hospital, who led the study. "There was an option to defer treatment before because the [prior] treatments were significantly more toxic and the risks often outweighed the benefits. Now, with safe and highly effective treatments, morally and ethically there's no option to not treat, particularly for those with more advanced disease."

Read more.....