February 20, 2024

Direct-acting antivirals (DAA’s) to treat hepatitis C have now been available in the U.S. for many years, so why hasn’t the U.S. made significant progress in eradicating the infection?

Over the past decade:

Notable Facts

• In the U.S., only about a third of the 1.7 million people diagnosed with hepatitis C between 2013 and 2022 have been cured, while other high-income countries are on the path to fully eliminating the viral infection.
• There are currently seven direct-acting antivirals (DAAs) on the market that have been approved by the Food and Drug Administration (FDA) to treat hepatitis C. All offer cure rates of over 95% after 8-12 weeks of treatment.
• The list price of most DAA treatments has come down from around $84,000 to about $24,000 per course of treatment since Sovaldi, the first drug in this class, hit the market in 2013.
• Only 35% of people with hepatitis C who have private insurance coverage initiate treatment within a year of diagnosis.

The Problem at Hand

• A lack of vaccines and costly treatment: While there is no vaccine for hepatitis C, DAAs cure around 95% of cases. However, the roughly $24,000 price tag in the U.S. still presents a major cost barrier.
• Multistep testing delays diagnosis: Currently, there is no one-step test to detect the virus, resulting in delayed patient diagnosis and treatment.
• Asymptomatic people not tested: About 75% to 85% of people with acute hepatitis C are asymptomatic, so they do not think about testing. As a result, the rate of testing is limited, and many are unaware of their infection status.
• Health disparities: Death rates from hepatitis C are up to 3.4 times higher for racial minorities than for non-Hispanic White people.
• Low treatment rates among younger people on employer insurance: The highest rates of hepatitis C are among individuals 40 and under. They are more often covered by employers, but they have lower rates of treatment compared to those 40 and older.
• Stigma can discourage screening and treatment: Diagnosis with hepatitis C coupled with perceived stigma can significantly impact social functioning and reduce the desire to seek screening and treatment. Privacy concerns also play a role in screening and treatment delays. These factors make the potential for a rise in the disease’s incidence rate more likely.

Public Health Initiatives

• A 2023 proposal from the Biden Administration is calling on Congress to fund an $11 billion program that would cover the cost of medications and fund development of new tests to detect hepatitis C infection.
• The Biden Administration intends to implement a plan that would allow states to pay pharmaceutical manufacturers a lump sum to make hepatitis C drugs available for free to those on Medicaid and without insurance.
• Since 2019, Louisiana, Washington and Michigan signed purchasing agreements with DAA manufacturers to procure an unlimited supply of these medications for a set fee to treat Medicaid beneficiaries and people in the states’ prison systems.

What Can Employers Do to Aid in the Effort?

• 1 |   Identify at-risk members: Work with your partners to assess how many at-risk plan members have received testing and how many with hepatitis C have received treatment.
• 2 |   Encourage follow-up testing where needed: Work with your partners to encourage patients to remain engaged depending on their individual risk and ensure that they are monitored for long-term outcomes.
• 3 |   Review hepatitis C formulary decisions: Make sure that your plan covers at least one hepatitis C medication for each genotype of the virus. Evaluate pharmacy benefit manager (PBM) formulary determinations to make sure that plan members and employers have options that are the lowest net cost available.
• 4 |   Review prior authorization (PA) criteria: Collaborate with your PBM to reassess and modernize PA protocols and remove unnecessary barriers to receiving care, as more strict PAs may still be in place due to the initial high price tags of the medications.
• 5 |   Develop communications to raise awareness and reduce stigma: Ensure that communications about hepatitis C give employees confidence that their privacy is respected and protected. Assess employer and partners’ messages for potentially stigmatizing language while encouraging awareness of risk factors and the potentially asymptomatic nature of the disease.

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Pharmacy Preventive Services