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Yale Study Finds A Quarter Of Patients Are Initially Denied Hep C Treatment

Gilead Sciences Inc.

A newly published study says a quarter of patients seeking new drugs to treat Hepatitis C while enrolled in the Yale Viral Hepatitis Program were denied by their insurance companies, both public and private.

The study was published on Thursday in the medical journal PLOS ONE. It looked at 130 patients enrolled in the program during the fall of 2014.

Dr. Joseph Lim of the Yale School of Medicine led the study. He said the new drugs are 90 percent effective at curing Hepatitis C. Hepatitis C infects the blood, and can cause liver disease or cancer if it goes untreated. Lim says some patients with early stages of the disease have to wait for their drugs, because insurance companies say they’re too expensive.

“Most insurers are hoping that patients can safely wait until the cost of treatment goes down in the future,” said Lim. “But the risk that is taken is that a subset of these patients that have milder disease, they may suffer the consequences of chronic infection: Cirrhosis, liver failure, and liver cancer.”

Lim said insurance companies may be denying patients treatment at a higher rate nationwide. He said that since his study ended in December 2014, many insurance companies now require a liver biopsy to prove a patient has liver disease, which demonstrates “urgent need” for the new drug.

This week, experts from the Public Health Service and President Obama’s Advisory Council on H.I.V./AIDS asked White House Officials to Federal and state Medicaid officials should widen access to prescription drugs that treat Hepatitis C, according to The New York Times.

But he said Connecticut and New York’s Medicaid programs are an exception. They actually loosened those restrictions earlier this year to allow virtually all Hepatitis C patients access to treatment.

Clare Krusing, director of communications at America’s Health Insurance Plans, a national association for public and private health insurance providers, said more patients would get getting timely treatment if the drugs were cheaper.

“If the focus is on improving access to this medication overall, then that means fundamentally addressing the price of the drug,” Krusing said. “And drug makers, they price this medication at an exorbitant cost. For patients, for the health system, overall.”

The new drugs retail between $84-95,000 for a 12-week treatment, according to Lim. He said insurance companies typically get about a 40 percent discount on oral drugs, which he said are more effective, and less toxic, than the older intravenous treatments.