Jun 24, 2014 — New treatments for the “Hep C” virus may be prohibitively expensive. When costs reach $1,000 a pill, insurance companies begin to balk. Dr. Tom Miller and Dr. Juan Gallegos examine the cost of treatment versus the human costs of living with Hepatitis C.


Host: Hepatitis C, is the cost greater than the cure?

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Host: I'm with Dr. Juan Gallegos today. He's a member of the Division of Gastroenterology. He's also a specialist in liver disease and he's a member of the Department of Medicine. Juan, we want to talk today about the cost of treatment for Hepatitis C. It's expensive, isn't it?

Dr. Juan Gallegos: It definitely is expensive especially with new drugs that have come to market over the last six months. And one of them in particular has got a lot of press out there and it's called Sofosbuvir. And the cost for a 12-week treatment duration of therapy is $84,000 which basically is $1,000 per pill.

Host: And the cure rate is higher with this pill than our treatments in the past. Right?

Dr. Juan Gallegos: Yes, it definitely has broadened our ability to treat Hepatitis C and cure Hepatitis C, so it is much better than what our treatments were before, but has come at this financial cost. But to put this in perspective though, the prior treatments which were a combination of an injected drug called Interferon, an oral pill called Ribavirin, and a couple of new different antivirals that were approved in 2011. The duration of that treatment was about 48 weeks and the cost was about 100 or $120,000 for the whole treatment. So even though this new medication seems to be very expensive in comparison to the other therapies that we used for Hepatitis C, it's around the same price. The advantage now though is that we have higher cure rates.

Host: Well, less side-effects too.

Dr. Juan Gallegos: And less side-effects and less duration of treatment. The treatment is less cumbersome, and it also requires less monitoring from your physician. So you need less blood tests and less visits to your doctor when you're taking these pills.

Host: So even though it's expensive, it's cheaper than the other options. Right?

Dr. Juan Gallegos: Well, it is because if you think about, if you don't cure the Hepatitis C in a timely fashion, then patients will go on to develop cirrhosis and complications of the cirrhosis such as liver cancer or other complications that might end up making this patient needing a liver transplant.

Host: Yeah, and I haven't even talked about the discomfort and the unfortunate nature of people who have that problem in spite of the cost. When one gets to that phase their life is dramatically different.

Dr. Juan Gallegos: Yes, that's definitely true. Their quality of life is decreased. Their ability to work decreases and hence, they become less productive and not able to care for themselves or their families. And ultimately they might end up requiring a liver transplant which is a much more expensive alternative than trying to cure the viral hepatitis before this happens.

Host: Well, in your experience, does most insurance cover this treatment?

Dr. Juan Gallegos: So yes, most insurance do. And the fact is that these new treatments were approved by the FDA just recently, so there is clearly an indication for therapy of Hepatitis C. So most insurance companies do approve them. We do have to get them, what we call preauthorized, so we have to give the insurance companies information on the patient and rationale behind why we're using this specific therapy.

Host: Have you had to turn anyone away or have people opted out because they simply can't afford the medication having no insurance?

Dr. Juan Gallegos: So without insurance, yes, it would be very difficult to treat somebody. But that said, the pharmaceutical companies do have programs where they can assist patients with either their co-pays or if they don't have any insurance, sometimes they'll be able to provide the medication at a much lower cost.

Host: And would a patient work through their doctor to see if they qualify for one of those programs?

Dr. Juan Gallegos: Yes, we would definitely help them get through that. And so far at least, the patients that we have treated here at the University of Utah, most of them are insured. We have been able to successfully get them through therapy or on treatment at this time.

Host: And I'm also thinking with the Affordable Care Act there is no pre-existing condition clause that prevents people from buying insurance now. So if they were able to get on one of the exchanges and obtain insurance, they would probably be able to get the treatment as well.

Dr. Juan Gallegos: Yes, that's true. The only thing there is that certain insurance companies are more visual and in regards to authorizing these medications to all comers.

Host: Check the plans.

Dr. Juan Gallegos: Correct. Check your plan.

Host: Check the plan before purchasing insurance.

Dr. Juan Gallegos: And then the insurance companies will take things on a case by case status and be able to determine whether this particular person requires or not these newer therapies.

Host: Thank you very much.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.

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