Paying For Solvadi, The New Hepatis C Treatment

Millions of people around the world, about 170 million, are infected with the particularly persistent virus hepatitis C. Relatively rare in northern Europe, the virus infects 0.01 to 0.02 percent of people in the UK, about 1 to 2 percent of people in southern Europe, 6 percent of the population of sub-Saharan Africa, and up to 22 percent of the people of Egypt, where the virus was spread by the use of contaminated blood products. Although the virus can be spread by sexual intercourse, it is more often spread by shared, contaminated needles, both in illicit drug use and in medical settings. About 10 percent of cases occur in healthcare workers who are accidentally exposed.

In the United States, hepatitis C is most commonly a disease of African-Americans aged 20 to 40. These Americans in their younger, active adult lives are beset with a range of  hepatitis C symptoms that start as joint pain, dry skin, dry eyes, shooting pains, numbness, and muscle pain and progress to bleeding from the throat, swollen ankles, and mental fuzziness and finally signs of liver disease, such as clubbed fingers, yellowing of the skin and eyes, rashes on the palms of the hands, breast enlargement in men, wasting of muscles, hernia around the belly button, and severe fatigue. 

Not everyone who is infected with hepatitis C (also known as HCV) dies from the disease. A few people are able to fight off the infection, and only about one in five develops the symptoms described above. About one in ten develops liver cancer (hepatocarcinoma).

Older Medications For Hepatitis C Work, But Pose Serious Side Effects

Treatment for hepatitis C has been available for over 25 years. An antiviral treatment known as interferon, typically used in combination with a second antiviral drug called ribavarin, usually "knocks out" the infection at least for a few years. The problem with interferon and interferon plus ribavarin has been that the side effects are often considered to be as bad as the disease itself.

Interferon treatment can, and more often than not does, cause:

• Headache.
• Depression.
• Emotional instability.
• Lower white and red blood cell counts.
• Growth of scar tissue in the lungs (interstitial fibrosis).
• Hair loss.

Ribavarin treatment can cause:

• Birth defects in women who become pregnant while on the drug.
• Low red blood cell counts.
• Gout.

The side effects of treatment are so unpleasant that many people with hep C simply give up. However, for two years, there has been a treatment that works for all four strains of the hepatitis C virus and sometimes results in a complete cure in just 12 or 24 weeks.

READ New Pill To Treat Hepatitis C

Solvadi (Sofosbuvir) Works, But Is Prohibitively Expensive

Since the beginning of 2014, Americans and people in most of the world have been able to buy a medication called sofosbuvir, marketed in most of the world as Solvadi. The big advantage of Solvadi is that, although it is used in combination with other drugs, it only has be taken for 12 to 24 weeks, and in about 90 percent of cases (when the infection has already caused cirrhosis of the liver) to about 99 percent of cases (when the infection is an earlier stage) using the drug results in a cure. It is particularly helpful for African, African-American, and Hispanic patients who don't respond well to other treatments. However, the problem with Solvadi is its cost.

Hepatitis C Patients: How To Get Around The Cost of Solvadi

In the United States, getting 12 weeks of treatment with Solvadi is billed at $84,000. Naturally, health insurance companies would prefer that their patients get a cheaper, less effective drug. Many of the people who need the drug most have been sick for years, have become impoverished, and rely on government assistance for their healthcare. State Medicaid budgets, aiding the poor, have been so strained by the cost of the drug that some states, such as Texas, won't pay for the drug at all. 

Gilead Sciences, Inc., the company that makes Solvadi, has licensed 11 companies in India to make a generic version of the drug at affordable prices (about $1,000 per patient) in 91 countries in the developing world. However, it is not yet offering a discount for hepatitis C patients in middle-income countries such as Russia, China, Brazil, Serbia, or Ukraine. Treating the 40 million people who have hepatitis C in those countries would cost (and earn the company) over $3 trillion at the rates it charges in the United States. Worldwide, the drug would earn the company, in theory, over $20 trillion, or about 1/5 of the total wealth of the United States, just for one medication.

Naturally, organizations like the  Initiative for Medicines, Access and Knowledge, based in New York City, are filing legal challenges to make the medication more widely available in the countries where it is needed most. Court challenges, however, take years, and in the meantime, patients need treatment. Here are some ways to try to get the medication if you and your doctor believe you would benefit from it. Since the most difficult place in the world to get the drug is the United States, where the company charges the most, here is what you need to know.

• Some insurance plans (such as Health Net, Blue Cross/Blue Shield, Anthem/Express Scripts, Aetna, CVS/Caremark, and Humana) cover the drug but only with prior authorization.
• To get prior authorization, your doctor will need to certify that (1) you have agreed in writing to cooperate with your treatment and stick with the drug until it has a chance to work, (2) you don't have a condition (such as kidney disease) that would be made worse by Sovaldi, (3) you have a diagnosis of chronic, compensated liver disease and (4) a liver biopsy has found that you have scar tissue in your liver. (Also, women who could become pregnant must agree to use contraception, in order to prevent birth defects.) The fourth requirement is a problem for about 70 percent of people who have hepatitis C, because they are sick enough to need treatment but don't yet have changes in the liver itself.
• Most plans will also require documentation that you have not used illegal drugs for at least six months before they authorize the treatment.

It's entirely possible that a Silver Plan with premium assistance (referring to the Obamacare categories) could result in your having to pay nothing at all if you have already met your copays and maximum out of pocket for the year.

READ New Drugs Make Hepatitis C Curable

What Can You Do If Insurance Won't Pay For Hepatitis C Treatment?

Then you can ask the maker of the medication, Gilead Sciences, for help through its SupportPath program. This program covers both Sovaldi and Harvoni (the combination drug) with coupons that can lower the price of the medication to as little as $5 a month. Acceptance into the program is not automatic, and you will have to provide financial information and explain how you have tried to get insurance coverage, plus you will need your doctor to sign and send the form for you. However, many patients get the drug they need this way. A link to the application form is provided below this article.