Hepatitis C Treatment Costs: What to Expect

Hepatitis C is a liver infection caused by the hepatitis C virus (HCV). For some people, HCV infection only causes short-term illness. However, for more than half who become infected, HCV can become a chronic infection that leads to liver injury and even death if left untreated.

Prior to the introduction of a new class of drugs called direct-acting antivirals (DAAs) in 2013, hepatitis C was very difficult to treat. Today, DAAs offer cure rates of more than 90%.

So successful are these new drugs that both the American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society of America (IDSA) have recommended immediate treatment of all people diagnosed with acute or chronic hepatitis C (with the exception of those with a short life expectancy owing to liver disease).

Even so, the drugs are extremely costly. A single tablet of one medication can cost in excess of $1,000 per pill. As a result, some insurance companies may initially deny coverage for some of these drugs, requiring persistence by the patient to get them approved.

This article takes a look at the high cost of hepatitis C treatment, what to expect when undergoing treatment, and ways to reduce the out-of-pocket expenses associated with HCV therapy.

Hepatitis C Treatment

Hepatitis C was only officially identified as a unique hepatitis virus in 1989. By 1991, the Food and Drug Administration (FDA) approved the first treatment for HCV—ribavirin and interferon-alfa. Interferon-alfa had a cure rate of only 6%.

While newer and more effective therapies were introduced over the next 20 years, it was only with the 2013 introduction of the first DAA, Sovaldi (sofosbuvir), that the game officially changed. A virus once considered incurable was now curable in over 90% of cases, including in people who had previously failed HCV treatment.

On top of that, the drugs were far less toxic and required shorter treatment times than previously thought possible.

The aim of the current HCV therapies is fivefold and includes:

• To clear all hepatitis C virus from your body permanently
• To stop or slow down the damage to your liver
• To reduce your risk of cirrhosis (advanced liver scarring)
• To reduce your risk of hepatocellular carcinoma (liver cancer)
• To reduce your risk of liver failure and the need for a liver transplant

Today, there are five combinations of DAAs approved for the treatment of hepatitis C. Each is a fixed-dose combination drug composed of two or more active agents. Each is taken by mouth, some with food and others either with or without food.

The drugs also vary by which genotypes (genetic strains) of HCV they treat and how long they need to be taken.

One of the most notable features of all DAAs is their price. They are all costly.

What to Expect

Before starting HCV therapy, you will undergo blood tests—called genotyping—to determine which HCV genotype (or genotypes) you have in your blood. This will help determine which DAA is the best fit for you as an individual.

In addition to genotyping, other factors help inform the drug choice and duration of therapy, including:

• Your age
• Whether you have previously been treated for HCV
• Whether you have cirrhosis
• Whether you have compensated cirrhosis (in which the liver is still functional) or decompensated cirrhosis (in which liver function is acutely deteriorating)
• Drug cost and availability

Once the DAA is prescribed, it is taken once daily for eight to 24 weeks. In certain cases, ribavirin may also be prescribed.

The different DAA drugs work in unique ways to prevent HCV from making copies of itself. When taken as prescribed, DAAs can reduce the amount of virus in the blood to undetectable levels (as measured by a blood test known as the HCV viral load).

If the hepatitis C virus RNA remains undetectable for 12 weeks after the completion of therapy, it is referred to as a sustained virologic response (SVR). The treatment can be considered successful, and the infection can be considered cured.

Challenges and Limitations

Despite the exceptionally high cure rates, not everyone on HCV therapy will achieve SVR-12. If this happens to you, it may be because you're not taking your drugs as prescribed, or it may be because you have an HCV genotype that is difficult to treat (such as HCV genotype 3 which is seen more commonly in Asia).

During the eight- to 24-week course of treatment, your healthcare provider will check your viral load at certain intervals to assess whether the drugs are working as they should.

By week four, a 99% drop in viral load—referred to as an early virologic response (EVR)—is usually a strong indication that you will achieve SVR-12. By week 12, the inability to achieve a two-log drop in viral load (for example, a drop from 1,000,000 to 10,000) is generally regarded as treatment failure.

Getting Help With Hepatitis C Costs

The biggest challenge for some is not achieving SVR-12 but affording the cost of HCV therapy. Even if you are able to cover the out-of-pocket expenses, your health insurer might very well deny your request for treatment.

This doesn't mean you should give up or wait until your condition gets worse before trying again. There are different steps you can take to not only access treatment but make the drugs more affordable.

Health Insurance

Despite recommendations by the AASLD, IDSA, and others to start treatment on diagnosis, it is not uncommon for health insurers to deny coverage for people with HCV in some states. This is especially true for people on Medicaid, who typically are of low income and less able to afford health care.

Medicaid programs vary by state, and some states have instituted policies that restrict access to DAAs based on whether your liver damage is "severe enough" or whether you have successfully completed an alcohol or drug treatment program. Both are regarded as unnecessary and discriminatory practices.

If you are among those who have been denied treatment, you have the right under federal law to appeal the judgment. There are different requirements and deadlines for filing an appeal, so it often helps to work with a liver specialist, such as a gastroenterologist or hepatologist, who is experienced in providing a rationale for treatment.

If you cannot afford a liver specialist, you can often find low-cost or no-cost providers through the federal government's Health Resources Services Administration (HRSA) online health center locator.

According to research from the Kaiser Family Foundation, around 40% of all health insurance denials are overturned in appeals, although the success rate can vary by the insurer.

Patient Assistance Programs

Patient assistance programs are offered by drug manufacturers for people without insurance as well as those with insurance who simply cannot afford the out-of-pocket costs.

Eligibility is typically based on whether your family's annual income falls at or below 400%–500% of the federal poverty level (FPL). Other manufacturer-subsidized programs are easier to access, providing assistance to not only low-income families but middle-income earners as well.

If you meet the eligibility requirements, the programs may help you cover:

• Co-pay costs (the predetermined amount you pay for a doctor's visit or prescription)
• Coinsurance (the percentage of costs you pay after you've met your deductible)
• Deductibles (the amount you pay for health care before key insurance benefits kick in)
• Insurance premiums (the amount you pay each month for your policy)
• Travel expenses for medical care

Nonprofit Financial Assistance

In addition to manufacturer's assistance programs, there are non-profit programs that provide financial assistance for hepatitis C treatment. You often have to check when funds are available, but, when they are, some organizations like the HealthWell Foundation offer grants of up to $30,000 per year for hepatitis C treatment.

Among the non-profits offering hepatitis C financial assistance are:

• Good Days
• HealthWell Foundation
• Hepatitis C Association Help4Hep
• Patient Access Network (PAN) Foundation
• Patient Advocate Foundation
  
• Patient Services, Inc.
• The Assistance Fund

As with manufacturer's assistance programs, nonprofit assistance programs are based on you or your family's annual income. Generally, incomes that fall at or below 500% of the FPL qualify.

Drug Discount Cards

There are some specialty pharmacies and nonprofit organizations that offer drug discounts to reduce the cost of hepatitis C medications. Discounts can vary, but it is not uncommon to reap savings of 30% or more.

Among the discount programs that can assist with hepatitis C treatment costs are:

• GoodRx
• NeedyMeds (a service of the American Liver Foundation)
• Optum Specialty Pharmacy
• Rx Outreach
  

Clinical Trials

Clinical trials, which are research studies to evaluate a medication or therapy before it is offered to the public, are another possible avenue for treatment, offering you benefits you might otherwise be unable to afford. If accepted into a study, you are typically provided medications, blood work, and clinical monitoring free or change. Some studies even pay their participants.

By participating in a clinical trial, you may benefit from the latest advances in medical science. In some cases, you may have access to new and improved treatments before the general public or be able to access treatment sooner than if you had to wait for insurance authorization.

Clinical trials may also be a good option if you have repeatedly failed HCV therapy and have yet to achieve SVR-12.

Ask your liver specialist about clinical trials you may be qualified for, or check the ClinicalTrials.gov website for hepatitis C studies actively recruiting volunteers.

Summary

The treatment of hepatitis C was transformed in 2013 with the introduction of a new class of drugs called direct-acting antivirals (DAAs), which today afford cure rates of over 90%. Even so, the drugs are expensive, and some health insurers have been known to deny coverage, particularly certain state Medicaid programs that restrict access based on disease severity or sobriety.

If faced with an insurance claim denial, you have the right to appeal the decision, ideally with the help of a gastroenterologist or hepatologist. You may also be eligible for patient assistance programs from drug manufacturers and nonprofit organizations like the PAN Foundation, which may cover some or all of the cost of treatment.

If you are ineligible for financial assistance due to your income, drug discount cards from specialist pharmacies and non-profit programs like NeedyMeds can help defray out-of-pocket expenses. You can also opt to participate in clinical trials, which may provide you access to hepatitis C therapies not yet available to the public or to medical care that might otherwise be unaffordable.

A Word From Verywell

Hepatitis C is more common than many people imagine. In the United States alone, 2.4 million people are thought to be infected, a great many of whom have no symptoms at all. Many of these infections occurred before 1965 when measures were put into place to screen the U.S. blood supply for viral hepatitis.

Because of this, the Centers for Disease Control and Prevention (CDC) recommends one-off testing for hepatitis C for all people aged 18 years and over, as well as for pregnant people with each pregnancy.

By getting tested early, you can get treated early and avoid any long-term injury to your liver.