Hepatitis C Medications: Costs, Side Effects, and More

Written by Colleen M. Story | Published on July 21, 2014
Medically Reviewed by George T. Krucik, MD, MBA on July 21, 2014

Traditional vs. New Treatments

Hepatitis C infection can be cured, or “cleared” from the body. Traditional treatments, though, are often long and drawn-out, and may involve a number of uncomfortable side effects.

Fortunately, newer, more advanced medications are coming to the market. These reduce the length of treatment and have fewer side effects. According to clinical trials, they are also more effective at clearing the virus from the body than traditional treatments.

The only barrier left to widespread use of newer treatments is cost. Curing one patient can total more than $80,000.

Treating Hepatitis C: Traditional Medications

Not everyone who contracts the hepatitis C virus requires treatment. Some patients are able to eliminate it on their own. Those who can’t may soon develop symptoms. Symptoms often include:

  • pain in the upper abdomen
  • fever
  • jaundice
  • loss of appetite

Without treatment, hepatitis C can cause serious liver problems and even liver cancer.

Once a hepatitis C infection is diagnosed, doctors proceed with treatment. The goal is to protect the liver from damage and to clear the virus from the body. Traditional medications are described below.

Interferon and Pegylated Interferon

Interferon is a type of protein that stimulates the immune system. The type used in hepatitis C treatment helps stop the virus from spreading. It also protects healthy cells from infection.

Pegylated interferon has been altered to make it last longer. A combination of three types of interferon, it also includes polyethylene glycol (PEG). This helps it stay in the body for a longer period of time. This means that patients don’t have to receive as many injections.

Side effects of interferon and pegylated interferon include:

  • flu-like symptoms
  • drop in platelets and white blood cell count
  • loss of appetite
  • nausea and other digestive ailments
  • hair loss
  • increased blood sugar levels
  • insomnia
  • weight gain or loss
  • fatigue
  • changes in thyroid function

Ribavirin

This is an antiviral medication that helps stop the hepatitis C virus from replicating. It’s usually used in combination with interferon. Pegylated interferon with ribavirin is known as “Peg/riba therapy.”

Ribavirin side effects include:

Combination Therapy

Combination therapy is more effective than interferon alone. Yet traditional medications do not have a 100 percent cure rate. They work better for those with certain strains of the virus, and not so well for others.

A 2010 study reported that pegylated interferon and rivabirin were about 54 to 63 percent effective against the hepatitis C virus.

Side effects of interferon and ribavirin can be so disruptive that they may cause some patients to stop treatment prematurely.

Newer Antiviral Medications

Today, doctors use newer antiviral medications with interferon and ribavirin to achieve better results against the hepatitis virus. This is often referred to as “triple therapy.”

The first group of new medications is called “hepatitis C protease inhibitors.” These drugs bind to the enzyme “protease.” This blocks the virus from using the enzyme, so it can no longer replicate and spread. A few types of hepatitis C protease inhibitors are described below.

Boceprevir (Victrelis)

Doctors use this medication in adults with stable liver disease who haven’t been treated yet for hepatitis C. They may use it in those who have not experienced good results with previous treatment. It works only on a certain type of virus — the “genotype 1” infection, which is the most common type.

Side effects may include:

Telaprevir (Incivek)

This medication is similar to boceprevir. It works only on genotype 1 infections. Doctors usually prescribe it with interferon and ribavirin. Those who take it may suffer severe skin reactions like swelling, burning, and rash. 

Other side effects include:

Late-Breaking Hepatitis C Medications

After the introduction of boceprevir and telaprevir, the FDA approved a new drug called simeprevir (Olysio). This medication provided patients with the convenience of a once-daily treatment. The release of sofosbuvir (Sovaldi) followed shortly thereafter.

Simeprevir (Olysio)

This medication is similar to those listed above. It works only on genotype 1 infections. Doctors usually prescribe it with interferon and ribavirin. The difference is that it’s a once-daily treatment. That is much more convenient for patients. It’s also more effective, increasing cure rates. 

Potential side effects include:

  • fatigue
  • headache
  • nausea
  • insomnia

Sofosbuvir (Sovaldi)

A few months after simeprevir came out, so too did a slightly new type of drug called a “polymerase inhibitor.” Like those above, it stops the action of a certain enzyme the virus needs to grow. It offered a number of advantages over older treatments.

This medication is similar to simeprevir. It’s a once-daily antiviral treatment. The difference is that it can treat genotypes 1, 2, 3, and 4. It must still be used in combination with other drugs. When combined with ribavirin to treat types 2 and 3, interferon is often not necessary. As a result, patients may experience fewer side effects. It also shortens treatment time from the standard 24 weeks to only 12 weeks. It’s tolerated well by most patients, and typically produces milder side effects.

Side effects may include:

  • headache
  • insomnia
  • anemia
  • fatigue
  • nausea
  • a drop in white blood cells (in rare cases) 

The drawback to this medication is its cost. Treatment can total $1,000 a day.

Costs of New Hepatitis C Medications

Newer medications produce higher cure rates, which is exciting for patients. The cost, though, remains a major concern. Solvadi runs about $1,000 a day. A full treatment can total about $85,000-$90,000. Olysio totals about $65,000 for a full treatment regimen.

The costs are similar for older medications. Because older medications are more established in the industry, insurance companies typically offer coverage for them. Coverage for more advanced therapies, though, is not always guaranteed. In some states, Medicaid will offer coverage only for those in advanced stages of the disease. Patients are required to get authorization from Medicare and Medicaid plans before using Solvadi.

Those with private insurance may or may not receive coverage. Some companies have put restrictions on new treatments because of their costs, and because of how many people need them. Some may offer coverage, but with substantial copays. Drugmakers Gilead (Solvadi) and Johnson & Johnson (Olysio) also have programs to help qualifying patients reduce out-of-pocket costs.

As more treatments come to the market, they’ll provide competition, which will likely drive costs down.

New Treatments Coming Soon

Scientists continue to search for newer, more effective treatments. In 2014, the New England Journal of Medicine published three studies on drugs that show great promise in treating the disease. 

In the first study, scientists looked at a new protease inhibitor called ABT-450. When they used it with other antivirals for 12 weeks, it was highly effective against genotype 1. 

In the second study, researchers found the same combination treatment was 95 percent effective at treating patients with genotype one. These patients had not responded well to treatments in the past. Neither treatment involved the use of interferon. 

In a third study, scientists combined sofosbuvir with another new antiviral, ledipasvir. They tried the combination with and without ribavirin for 12 and 24 weeks. The combination, both with and without ribavirin, was effective against previously untreated genotype 1 infections in the vast majority of patients. 

It’s clear that newer, more tolerable, and more effective treatments are on the horizon. Advancements in medical science promise steady improvements. One day, hepatitis C may be a thing of the past.

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