February 16, 2018 – On Monday, February 12th, New York State Medicaid Director Jason Helgerson made news by announcing a potential path forward in the State’s response to its major hepatitis C epidemic at the joint Senate/Assembly budget hearing on Health and Medicaid. “We already have statutory authority to look at volume based discounts [for hepatitis C treatment],” Helgerson said in response to a question about improving New Yorkers’ access to hepatitis C treatment from ranking Senate Health Committee Member Senator Gustavo Rivera. “One of the things we’re going to do is—once the prices stabilize—is to look at possibly utilizing that statutory language to see if we can’t get ourselves an even lower price, which makes it even easier for us to actively promote the treatment.”
Volume based discounts on hepatitis C treatment could significantly increase the number of New Yorkers being cured of hepatitis C. This strategy is not a first for New York. Volume based discounts for Truvada for PrEP allowed the State to greatly expand access to this HIV prevention medication and put New York at the forefront of the national effort to end HIV as an epidemic.
Advocates for improved treatment access say that a similar volume based discount deal for hepatitis C cures could more than double the number of people cured of hepatitis C per year at the same cost to the State. “Right now there is a tremendous opportunity for both New York and treatment manufacturers to negotiate a deal to lay the groundwork for the statewide elimination of hepatitis C,” said Annette Gaudino, HCV/HIV Project Co-Director at the Treatment Action Group. “Manufacturers have the unique opportunity to gain market share and the State has the opportunity to cure more people at lower prices.”
“Hepatitis C is a curable disease and New Yorkers who have it should have access to every resource the State can offer,” said State Senator Gustavo Rivera. “Following an informative exchange at Monday’s hearing, I am thrilled to work with Medicaid Director Jason Helgerson to ensure that we make these necessary medications more affordable. Thanks to advocates like VOCAL-NY and COPE, New York will continue to be at the forefront of treatment-centered approaches to cure more people and prevent unnecessary deaths.”
“New York should take an aggressive tact in negotiating hepatitis C drug costs. As more competition enters the market, we should be working with these drug manufacturers to develop a purchasing agreement that allows for an expansion of treatment for New Yorkers. We are in a position to eradicate this disease and stop a growing epidemic,” said Assemblyman Ken Zebrowski, who was a leader in passing the State’s Hepatitis C Testing Law in 2013.
Hepatitis C treatment prices have already dropped significantly with the entry of the Merck & Co. drug Zepatier and the AbbVie Inc drug Mavyret into a market that had been dominated by Gilead Sciences. Merck has already offered an initial volume based discount deal that is being considered by the State.
The ambitious and achievable goal to cure every New Yorker living with hepatitis C is the key objective of the NYS Hepatitis C Elimination Campaign. As of this year, one hundred forty-seven hospitals, community health centers, and local departments of health endorsed NYS Hepatitis C Elimination Consensus Statement, calling on Governor Andrew Cuomo, the NYS Legislature, and industry partners to make a joint commitment to hepatitis C elimination, with a formal Task Force to establish a statewide elimination plan. The World Health Organization and the National Academy of Sciences have recently published feasibility studies and strategies endorsing the goal of hepatitis C elimination.
However, the national data show a deepening hepatitis C crisis. Last year, the U.S. Centers for Disease Control and Prevention (CDC) put out a report showing that the number of new hepatitis C infections reported to CDC nearly tripled between 2010 and 2015, reaching a 15-year high. The national increase in prescription opioid and heroin injecting has been linked to the increase in new hepatitis C infections. Another recent CDC report warned that hepatitis C is killing more Americans than the combined deaths of 60 other infectious diseases, including HIV.
“Not treating people with hepatitis C puts them in greater risk for liver cancer. We are seeing these rates rising,” said Ronni Marks, patient and founder of the Hepatitis C Mentor and Support Group.
Gail Brown, Coalition for Positive Health Empowerment (COPE), added, “It’s criminal that New York State has not already committed to eliminating hepatitis C. We have a known cure and considerably lower drug prices. Instead of taking advantage of this unique opportunity to pave the way for other states, New York is waiting for people to die.”
“It’s very encouraging to hear about these developments. But we also need the State Legislature to appropriate funds this year to build network capacity for outreach, prevention, hepatitis C treatment and treatment support,” said Charles King, President & CEO of Housing Works.
In New York State, approximately 280,000 people have been infected with hepatitis C, half of whom are unaware of their status. There were nearly 15,000 new hepatitis C cases in 2016, roughly five times more new hepatitis C cases than the number of new HIV diagnoses reported in the same year. Even with easy-to-take and extremely effective curative treatments on the market for the past seven years, approximately 1,000 New Yorkers still die annually from hepatitis C related causes.