The Challenges in Treating Patients with High Cost Hepatitis C Drugs

The second of 4-part interview with an infectious disease expert examines weighing the short-term high cost of treating HCV with curative drugs versus the long-term costs of treating the disease.

The infectious disease landscape has been evolving, largely due to advancements in treatment and technology. The CDC estimates that more than 1.2 million Americans are living with HIV. In the hepatitis C virus (HCV), between 130 and 150 million individuals worldwide have chronic HCV, of whom, approximately 700,000 will die each year from HCV-related liver diseases.

In part 2 of a 4-part exclusive interview with Specialty Pharmacy Times, Ron Nahass, MD, MHCM, FACP, FIDSA, discusses the impact of antiretrovirals and new blockbuster HCV drugs, challenges in the field, patient adherence, telehealth, and more.

Dr Nahass has been conducting infectious disease medicine for almost 30 years. He has had a long career in clinical research, and education in the area of chronic viral diseases, including HCV, hepatitis B, and HIV. He currently serves on the American Association for the Study of Liver Disease (AASLD) panel HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C.

Click here to read part one of this 4-part interview.

SPT: What are your thoughts on the high price tag of the blockbuster hepatitis C virus (HCV) drugs?

Dr Nahass: I am not a health economist, I don’t know what a fair price is, but you can’t simply look at it in isolation. The price initially when it came out was about $90,000 to get someone treated, the price currently is maybe $45,000 to $50,000 to get someone treated and cured. The downstream of that is they’re not going to end up with end-stage liver disease, they’re not going to get liver cancer, they’re not going to get cirrhosis. There’s got to be value to that, to society and to the overall health of the community. When you look at it compared to the price of other things—–because you can’t look at it in isolation––is it really that much more? I think it’s a normal issue for pharma and for society in general that the price of drugs is costly, but I’m not the right guy to ask what’s the right price.

Currently the annual cost for medications for someone with HIV is somewhere around $15,000 to $20,000 bucks. I’ve got plenty of people who I’ve treated for 20 years or more with those drugs. So, 20 years times $20,000, that’s $400,000. Is that too much? I have no idea. There’s a drug currently used for myeloma called Revlimid. Patients have to take it every day for years on end. Last I checked, I think that drug is about $80,000 a year. They may be on it for 10 years, that’s almost a million bucks.

Is the price of the hepatitis C drugs so out of the range of what happens with other drugs in life-threatening illnesses? It’s certainly not out of the range of what we pay for HIV care, and frankly, it’s cheap compared to the cost of drugs we use for oncologic care. I don’t know what the right price is, but I understand the argument.

SPT: Have your patients run into any issues accessing the new HCV drugs or with having insurance cover them? Are pharmaceutical companies helping patients pay for the medications through programs to help deal with the high financial burden?

Dr Nahass: That’s one of the frustrations for me is the access and/or approval process for the new drugs, it’s a pain in the butt. And it’s no question that is a frustration for the patients and the doctors.

For example, in New York state, they have now approved that all patients can be treated. New Jersey is not doing that. In New Jersey, we are only allowed to treat people who have stage 2 and above. In New York, you can treat stage 0, stage 1, and then stage 2 and above—–there’s 4 stages––but in New Jersey, we can’t treat stage 0 and 1, so that is a frustration.

Some of the companies have [payment programs], but it’s not always easy to access that and they’re certainly not offering to pay the whole freight for patients with stage 0 and 1. A few patients are able to access that.

SPT: Do you run into issues with patients being adherent to their medications?

Dr Nahass: Generally, that’s not such a problem because it’s only a short course of therapy, 12 weeks. Most patients have no issues with adherence for hepatitis C treatment. The 3-month treatment period is pretty easy, and the drugs don’t have any significant side effects. We don’t really run into that problem all that much, and it’s hard for me to even think of a patient where I’ve had that issue.

HIV is more of a challenge because it requires more therapy. I mean listen, we all forget something. I don’t care what you’re taking, even if you’re taking a vitamin—–[you] probably miss it 1 day a week, or 1 day a month, or 1 day every 2 months. Some miss it even more. [But] missing a drug in HIV care runs the risk of the virus becoming resistant, which would make it more difficult to treat.