More than 95% of people infected with hepatitis C can be cured with a simple course of antivirals. But over 2 million adults in the U.S. are still living with the virus, and a new report by the Centers for Disease Control and Prevention may help explain why.
The agency looked at nearly 50,000 insured patients diagnosed with hepatitis C between January 2019 and October 2020 and found less than one-third received treatment within a year of their diagnosis, according to the study published Tuesday in the Morbidity and Mortality Weekly Report.
Treatment was lowest among patients who had state-administered Medicaid plans, with about 23% receiving it. About 28% people covered by Medicare and 35% with private insurance received treatment within the year.
“Our study shows that there are large gaps in hepatitis C treatments persisting nearly a decade after a highly effective curative treatment was approved,” said Dr. Carolyn Wester, director of the CDC’s division of viral hepatitis.
Although the agency recommends everyone should be treated for hepatitis C, health experts say state eligibility restrictions and preauthorization requirements make receiving timely treatment incredibly difficult.
Hepatitis C is a liver infection caused by the hepatitis C virus, which is spread through contact with blood from an infected person. It can result in long-term health problems including liver damage, liver failure, cirrhosis, liver cancer and death.
It’s treated with antiviral medications given for 8 to 12 weeks, which, depending on the medication, can cost up to $90,000, said Dr. Omar Massoud, chief of hepatology with Cleveland Clinic’s Digestive Disease & Surgery Institute.
Insurance may help but many states force patients to jump through hoops before covering it.
According to a June report by Harvard Law School and the National Viral Hepatitis Roundtable, 38 states require a prescriber to receive prior authorization before covering treatment.
Nineteen states have substance use restrictions, where a patient must be counseled or abstain from drugs and alcohol for a period of time before receiving treatment. Twelve states have prescriber restrictions, where treatment can only be prescribed by a health care provider if they’ve received special training or are a specialist.
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Wester says these restrictions may be especially harmful to racial and ethnic minorities. The CDC report shows nonwhite Medicaid recipients had 27% lower treatment coverage than white recipients.
“People shouldn’t have to jump over hurdles to access lifesaving, cost-effective treatment,” she said. “Removing barriers to treatment is a critical step.”
Substance use restrictions can also hurt adults under 40, who the CDC report found had the lowest treatment rates compared to any other age group despite having the highest rates of new infection.
Hepatitis C is commonly spread in this age group through injection drug use. Imposing restrictions on treatment allows the virus to run unchecked through this vulnerable community, Massoud said.
“These young people need to be treated and treated quickly to stop the spread of infection,” he said. “Every day or every week they stay without treatment, they’re infecting other people.”
Cases of hepatitis C rates have skyrocketed as the opioid epidemic worsens, jumping from an estimated 2,700 infections in 2011 to 57,500 infections in 2019, according to the CDC.
While treatment rates among insured patients are worrisome, health experts are especially concerned about the uninsured. The CDC estimates at least 40% of Americans with hepatitis C are unaware of their infection.
In addition to removing state restrictions, the agency recommends providing testing and treatment at community clinics, syringe services programs, substance use treatment centers and correctional facilities to reach those who may not be insured.
Everyone should get tested for the virus at least once in their lifetime, according to CDC recommendations. People with ongoing risk factors should receive periodic testing.
“If we don’t treat people and meet them where they’re at … they’re going to enter the health system later on with advanced liver disease, cancer or death,” Wester said. “We simply can’t afford to not treat people.”
Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT.
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