BY EMILY WOODRUFF | nola.com
Louisiana officials are set to announce a deal with drug makers Wednesday aimed at providing broader access to a Hepatitis C drug for some of the state’s most vulnerable patients.
In an agreement shepherded through negotiations by Louisiana Health Department Secretary Rebekah Gee, pharmaceutical giant Gilead Sciences Inc. has authorized Asegua Therapeutics to distribute a medication that typically costs $24,000 per treatment to the state’s Medicaid patients and patients in state prisons in unlimited quantities for the next five years.
The generic version of the drug, called Epclusa, cures 98 percent of Hepatitis C cases.
The pricing model Louisiana has agreed to will be announced during a press conference Wednesday by Gov. John Bel Edwards, according to the Department of Health. Last year, the state spent $30 million on Hepatitis C drugs and treated only about 3 percent of those needing treatment.
The deal offers a test case in Louisiana for what has been called the “Netflix model” of drug pricing, a new purchasing model aimed at making high-cost drugs more affordable. Under the plan, the state will pay a set fee for unlimited access to the drug for a pre-determined period, similar to how Netflix charges people a subscription fee that allows for unlimited access to its shows and films.
The model Gee proposed has been in use in Australia since 2015, where at least 47,000 people were treated in the first two years. The Australian government paid $766 million for the same five-year unlimited supply deal Gee is brokering.
A recent study published in the New England Journal of Medicine found that a total of 104,223 people in Australia are estimated to receive treatment over the five years, working out to a cost of $7,352 per person.
To treat the same number of people with traditional per-pack pricing, the cost would be $4.92 billion. If Australia spent the $766 million on per-pack treatment, it would be able to treat only 14,038 people.
Louisiana has approximately 35,000 Medicaid patients with Hepatitis C and another 4,000 incarcerated people with the disease.
“Hepatitis C is the leading infectious disease killer of our time, and for tens of thousands a cure is out of reach,” Gee said in an earlier statement. “The strong support for a subscription model confirms that we are within reach of a breakthrough in public health that will lead in the long term to saving lives.”
For people like Damian Bellon, 24, a New Orleans resident who has had Hepatitis C since birth, the deal has been a long time coming.
Bellon saw a commercial for a new drug, Harvoni, back in 2014. Before then, he looked into other, earlier treatments, but they required injections, came with a slew of side effects and were meant to manage symptoms rather than cure the disease. He soon learned the cure he had waited a lifetime for was out of reach financially.
“I figured out that it cost a lot, a lot of money,” Bellon said.
The first iteration of the drug, Sovaldi, cost $84,000 for one course of treatment when it debuted in 2014. Gilead, the drug’s manufacturer, sold $10.3 billion worth of the drug in that year alone. The second version of the drug, Harvoni, cost almost $100,000 for one treatment.
When he went to a local clinic to seek cheaper treatment, Medicaid denied Bellon’s claim because he wasn’t sick enough.
“They made me think I would have to move out of the country (to get the treatment),” Bellon said.
While those who are privately insured generally have access to the cure, which is negotiated down to a lower price by insurance companies, the drug was not available for most low-income patients.
Medicaid currently covers the drug only when a patient is in late-stage Hepatitis C, measured by something called a fibrosis score, according to Dr. Jason Halperin, an infectious disease physician at CrescentCare in New Orleans.
“Fibrosis is a leathering of the liver,” said Halperin. The score ranges from 0 to 4 — 0 reflecting no signs of liver damage and 4 indicating end-stage organ damage. “In the state of Louisiana, you can only access it at stage 3 or 4,” said Halperin.
If a patient gets treatment when their fibrosis score is 1, they have an 80 percent chance of getting back to stage 0, according to Halperin. For patients getting treatment for the first time with a fibrosis score of 4, the chance of getting back to normal drops to 20 percent.
That’s also a problem for rates of infection. The sooner a person gets access to treatment, the smaller the chance they have of infecting others. It’s estimated that about 500 people are newly infected with Hepatitis C each year in Louisiana. Most of the cases go undiagnosed because the disease is largely asymptomatic at first. Only about 120 of those are reported.
About 150 people in Louisiana die each year from Hepatitis C-related causes. Across the U.S., it’s estimated that about 18,000 die from Hepatitis C per year. Carrying the virus also raises the risk of stroke, diabetes and heart disease.
The goal is to treat 10,000 people in Louisiana by the end of 2020. But Halperin said the benefits can ripple beyond that if the right populations are targeted for testing. Hepatitis C spreads most easily through intravenous drug use and anal sex, said Halperin.
“If I cure someone of their Hep C, they can’t transmit it. This is where we have intersection with the opioid epidemic,” said Halperin, who emphasized that eradicating the disease will be most effective if it goes hand-in-hand with efforts like clean needle exchanges, which get people most likely to be exposed to Hepatitis C in the door for testing.
Bellon was told the official launch date is sometime in July, which can’t come soon enough, according to infectious disease experts.
“It is the No. 1 infectious disease that people in the U.S. die from,” said Halperin. “Do people die quickly from it? No. But have people died waiting from 2014 to 2019? There is no question.”
Bellon expects he won’t get treatment until September.
“I kind of look at it as when someone is a kid, and they don’t know their eyes are bad. They go to the doctor, and their parents tell them to wear glasses,” said Bellon. “You have that perspective that something is fine because it’s what you know. But I’ve heard that after getting the cure, you feel lively, you want to get up for the day.”