your doctor, infectious disease specialist dr. Jose Bordon of Providence Hospital in Washington ran test after test and Tia’s Medicaid provider demanded proof of what strain of Hepatitis C Tia was infected with.
“They ask for more tests and they ask for specific tests,” Bordon said.
At tens of thousands of dollars per patient, insurance providers want to be as sure as possible that each patient will be cured quickly.
“we order zepatier next”, said tia. another not finally, the supplier of borden y tia decided on epclusa, one of the new drugs against hepatitis c.
tia started taking epclusa last year. she followed the instructions carefully.
“I had to stop drinking wine,” he said. “I had to go cold turkey without wine for three months. that’s a long time.”
but still, after a few weeks, it became clear that it wasn’t working.
Atia wasn’t downcast, but she was disappointed and a little scared.
Further tests followed. was it the resistance? Had the virus in her body somehow evolved to defy the effects of the drug? Was it a supplement you took?
Often, patients don’t take their hepatitis medications as they should. drug users may sell the valuable pills, or patients may forget doses, allowing the virus to mutate. Aunt didn’t fit into any category.
Borden now believes that one of the many “natural” supplements Tia had been taking probably interfered with the action of the drug, making it less effective and allowing the virus to survive in her body.
“supplements can ruin hepatitis c treatments,” said dr. Douglas Dieterich, director of the Institute of Liver Medicine at the Icahn School of Medicine at Mount Sinai in New York.
“can cause drug toxicity. they can interfere with liver enzymes that can reduce drug levels. the most common is st. Grass of San Juan”. st. St. John’s wort is a plant that many people use to treat symptoms of depression, but it is metabolized in the liver in a way that can interfere with many pharmaceutical drugs.
Atia had no idea herbal or “natural” supplements could do this.
“It was part of her normal life to take all these supplements,” Bordon said.
obstacles to treatment
now, aunt would have to try a different medication for hepatitis c. there are several on the market, but that’s where she ran into policy wars. many insurers are reluctant to pay for a second round of treatment.
“They don’t want to pay it unless you fight,” Tia said.
Solo said there are a few reasons for this reluctance, including cost. If all the Medicaid patients in a state showed up at once asking for treatment, “it would blow the budget,” she said.
Medicaid is a federal and state health insurance plan for people with low incomes and no other source of health insurance. Some states, like New York and California, invest heavily in their plans, while others have smaller budgets.
“Many states have put restrictions in place and said let’s try to prioritize the sickest first,” Salo said. “States were trying to buy time to give the price time to come down.”
Hepatitis C drug prices are falling as more companies develop their own versions and competition steps in. abbvie’s mavyret is priced at $26,400 per round of treatment, a price that has pressured other companies to lower their prices.
“Now that there are multiple drugs on the market, prices have obviously come down,” dieterich said. “Insurance companies have contracted with pharmaceutical companies and they have their preferred products,” he added.
But still, he said, insurance companies and state Medicaid programs often put up barriers if they can.
“There are always plans that try to get out of that… by testing us for alcohol or marijuana. even if you’re smoking pot, they’ll shut them out,” dieterich said.
Last October, the AIDS Institute, which also represents hepatitis patients, said 31 states and Washington, D.C. refuse to treat patients until they have moderate or worse liver damage.
or resist treating patients, like Tia, whose first course of treatment fails.
people can be cured of hepatitis c, but they are not immune from getting it again. some states fear that people who became infected through risky behaviors, such as injecting drugs, could become infected again and end up treating the same patients over and over again.
That’s short-sighted policy, argued alyson harty, director of clinical nursing at mt. sinai liver institute.
“Even if a patient doesn’t need a transplant, the cost of cirrhosis care for a patient in and out of the hospital for even a year is much higher than the cost of treatment,” he said.
and the cure rate is high. “In my office, more than 93 percent of patients treated for hepatitis are cured,” Bordon said.
‘we’re going to beat this’
In Tia’s case, Bordon performed the requested tests. filed an appeal with the insurance company that provides tia’s medicaid coverage.
“This is crazy,” Tia said as she waited to find out if she would be covered. “I called over and over again. How can an insurance company say that it will only cover one treatment in a patient’s lifetime?”
Because he had developed some cirrhosis, a board eventually determined that he was eligible for a second round of treatment. She was sick enough to qualify for vosevi, a three-drug combination for hepatitis C that is approved for cases like hers.
He started taking it in April and feels optimistic. “I hope my liver will regenerate,” she said.
borden said that the indications are that tia’s will and that the medication is killing the virus, he said. she will take the pills for three months.
two weeks later, aunt had good news. “The virus is almost undetectable,” she said.
“I feel good,” he added. “I have a plan. We are going to beat this.”
Update: As of July 20, after six weeks of treatment, a blood test could not detect any hepatitis viruses in Tia’s blood.