Just weeks into a new drug treatment for hepatitis C, Travis Poole felt like getting out of bed and going back to work as a painting contractor.
“I had new energy; I didn’t tire as easily,” he said. “My whole world did a 180, from knowing I was dying to knowing I had a new chance on life.”
Poole, 51, of Clovis, is one of the beneficiaries of a new — but expensive — drug for hepatitis C. Sovaldi, one of two pills that he took daily for 24 weeks, cost $1,000 apiece. The second cost $100 a tablet.
He was fortunate. His insurance paid for all but $480 in co-pays for pill therapy that cost more than $200,000. Without insurance, Poole said, it would have been impossible for him to pay for the new treatment that — unlike earlier therapies — has fewer side effects and provides a cure for the liver disease within weeks.
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Now, California is grappling with paying for the latest drugs for patients covered by Medi-Cal, the state-federal insurance for the poor and for others who rely on state health programs, such as inmates in the state’s prisons. A Fresno doctor who specializes in treatment of the liver disease says a decision by Gov. Jerry Brown to set aside $300 million in his proposed state budget for the expensive drugs won’t stretch far but is a good start in helping patients have access to life-saving treatment.
Brown’s proposal is “one step forward,” said Dr. Muhammad Y. Sheikh, chief of hepatology and professor of clinical medicine and surgery at the University of California at San Francisco-Fresno Medical Education Program. “At least somebody recognized to give something for hepatitis C.”
The governor’s proposal includes creation of a committee to determine the state’s approach to using the latest drugs for “thousands of inmates in state prisons, patients in state hospitals and participants in Medi-Cal and the AIDS Drug Assistance Program who are infected with hepatitis C.”
State health plans are following the governor’s proposal. “Setting aside hundreds of millions of dollars in the state budget for high-priced prescription drug costs is prudent, but those costs may only be the tip of the iceberg,” California Association of Health Plans said in a written statement after the governor’s budget was released.
An increase in patients and the six-figure prices for the new drugs could “soon become a budget-buster across state programs,” the association said.
The $300 million allocation could change, said Anthony Cava, a spokesman for the California Department of Health Care Services, which oversees Medi-Cal, the state’s version of Medicaid. The state expects more medications to be available and the competition could lower drug costs, he said, but at the same time, it expects more patients to need treatment.
According to a 2013 California Department of Public Health report, more than 600,000 people and maybe as many as 750,000 in the state have chronic hepatitis.
The state already has been paying for treatment with the new drugs. As of October 2014, nearly 1,700 patients had been given Sovaldi and another drug, Olysio, through the Medi-Cal program at a cost of $108 million.
The state’s prison system has 15,000 inmates who have tested positive for hepatitis C and have a detectable level of virus in their bodies. The state has treated 315 patients with advanced-stage disease with the new drugs at a cost of $85,000 to $95,000 per inmate, said Joyce Hayhoe, director of communications and legislation for the California Correctional Health Services. A substantial proportion (16%) of all newly reported chronic hepatitis C cases in California were reported from state prisons, according to the 2013 state report on hepatitis.
The new drugs are costly, Hayhoe said, “but they’re more cost-effective than an inmate who develops liver cancer because of hepatitis C or dies, because end-of-life treatment is very expensive.”
Sheikh said Medi-Cal has been paying for Sovaldi and another new medication, Harvoni, for his patients in the central San Joaquin Valley, but only as long as they meet certain criteria, such as advanced liver disease. Patients with complications — skin and kidney problems — can make a case for drug approval, he said.
It can take years for symptoms of hepatitis C to lead to diagnosis and treatment. Sheikh said the optimum would be to treat more patients earlier with the new drugs. “This should be every physician’s aim to make the people get rid of hepatitis C and we should not reach the point where the patient has already lost major liver function,” he said. “We should not wait for that time.”
Cost is an issue, however, Sheikh acknowledged. With the $300 million, only so many patients can be treated and some of funds might be better spent on prevention. A new, rapid antibody test can diagnose hepatitis C in 20 minutes in an outpatient clinic, he said. The test costs about $50. People with hepatitis C may have no symptoms but can spread the virus to others.
Recommendations are that Baby Boomers, people born between 1945 and 1965, be tested, Sheikh said. Risky lifestyle behaviors, such as drug use, body piercings, tattoos and multiple sexual partners were prevalent as this group came of age in the 1970s and 1980s, he said.
According to the state, 57% of reported chronic hepatitis C cases in California in 2011 were among those 45-64 years of age.
Poole now suspects he was infected more than 20 years ago when he got an 8-by-10 inch tattoo of a dragon, skull and tiger inked onto his right chest. He wishes he had been tested before he began having symptoms of extreme fatigue four years ago. “It would have made the difference of those years being good years instead of those being painful memories,” he said.
By the time he was referred to Sheikh and had a diagnosis of hepatitis C, Poole said the disease had progressed and “without treatment I would probably have had about five years to live.”
Now, virus free, Poole said he’s grateful that he had access to the latest hepatitis C drugs.
Sheikh said the drugs work. “We would like to treat everybody and these drugs are designed to treat everyone,” he said. “The only problem — cost.”