The following op-ed was written for The Capitolist by Eliot Godofsky, MD, an infectious disease specialist in Bradenton, Florida and a member of the Alliance for Patient Access.
The promise of the Affordable Care Act is ringing hollow for Floridians with hepatitis C.
Many hepatitis C patients who could cure their chronic condition with the help of new treatments are instead at risk for continued liver damage, liver cancer, or death. Their insurers, private companies offering publicly available health plans through an exchange created by the Affordable Care Act, don’t want to pay the high cost of treatment. So they require patients in Florida to pay thousands of dollars out of their own pockets before they can get the medication they need.
Though requirements vary by health plan, some Florida insurers are asking Affordable Care Act patients to first fulfill individual deductibles higher than $6,000 and then pay 30 to even 50 percent of the cost of hepatitis C cures. This approach reduces insurers’ spending, largely by encouraging hepatitis C patients to sign up for coverage elsewhere. But it hurts patients and may also violate non-discrimination measures of the Affordable Care Act.
Patients who cannot risk personal bankruptcy or simply do not have the money to pay for treatment are forced to go without therapy. In the case of hepatitis C, the Centers for Disease Control and Prevention tell us that up to 70 percent of patients go on to develop chronic liver disease, 20 percent develop cirrhosis of the liver and five percent develop liver cancer. As time without treatment passes, these patients’ condition worsens.
Plans also dodge hepatitis C treatment costs through extensive prior authorization requirements — requiring pregnancy testing, drug testing, proof of mental competency, treatment commitment letters and the like before giving the go-ahead for curative treatment. These prior authorizations, which contradict medical treatment guidelines, pose an added barrier for sick patients and time-strapped physicians.
Granted, insurers make a fair point about the price of hepatitis C cures. Treatments like Harvoni, Sovaldi and Viekira Pak cost tens of thousands of dollars per patient. The long-term value, however, often justifies these cures. Care for a chronic condition such as hepatitis C, decade after decade, across a vast patient population is costly. Liver transplants cost roughly half a million dollars, and the cost of treating liver cancer is likewise staggering.
More importantly, curing transmittable diseases such as hepatitis C provides a deeper value. It extends and saves lives, and it avoids unnecessary human suffering.
Given those facts, several government health care agencies have recognized the importance of treating and curing hepatitis C. Late last year the Centers for Medicare and Medicaid Services issued a notice to states reminding them of their legal obligation to provide necessary care to Medicaid patients, including those with hepatitis C. In March the Department of Veterans Affairs announced that, with the help of increased federal funding, it would forego restrictions for rationing care and treat all patients, regardless of their stage of liver damage.
Insurers in Florida may need a little prodding to follow suit. In an April letter, the Alliance for Patient Access and The AIDS Institute reminded Florida’s insurance commissioner that the Patient Protection and Affordable Care Act prohibits discrimination against patients based on health status. The groups urged him to take speedy action on behalf of hepatitis C patients.
As a physician, I can say that few frustrations compare with seeing a patient continue to struggle with a chronic disease solely because he or she don’t have deep enough pockets to pay for the cure. This certainly wasn’t the vision painted by the Affordable Care Act.
Florida can and must do better by its patients.
Photo credit: Dr.Farouk via Flickr.