Recent advancements in the fight against hepatitis C have transformed the disease from one that can, at best, be controlled to one that can be cured for a majority of people who have it.

A downside to the massive drug development efforts that proved so successful is the hefty cost of treatment. What’s hefty? Try $1,000 per pill, taken once per day, for 12 to 24 weeks. What makes these drugs so expensive? How can you make treatment more affordable?

What Is Hepatitis C?

Hepatitis C is a contagious viral infection that attacks the liver. This can lead to serious liver disease. This includes cirrhosis and cancer. Hepatitis C virus (HCV) is transmitted by exposure to blood or other bodily fluids of people who are infected.

Approximately 2.7 million Americans have a chronic hepatitis C infection. Between 1 and 5 percent of these people will die from cirrhosis or liver cancer.

New, Lifesaving Drugs

A few years ago, cure rates for the top-performing HCV drugs were around 50 percent. Most medications had to be given by injection. Almost all of the drugs had side effects so severe that some people abandoned the treatment.

The newer drugs cure up to 96 percent of people that take them. These drugs are called direct-acting antivirals. The U.S. Food and Drug Administration (FDA) approved the first of these medications for treatment of HCV in 2013. Several more medications have been approved since that time.

These medications are not one-pill-cures-all solutions. Instead, individual drugs are effective for specific strains, or genotypes, of HCV. The new medications may be used alone or, very often, in combination with other drugs. Most are available in pill form. Typically, these pills have far fewer side effects than previous treatment options.

The Cost of a Cure

At this time, there’s a short list of blockbuster HCV drugs. Because the FDA only recently approved these drugs, the companies that manufacture these medications have market exclusivity. The FDA determines how long this period of exclusivity will last. This gives the pharmaceutical companies a lot of freedom in establishing prices.

The pharmaceutical companies responsible for the development of the new HCV drugs have set the bar high for prices. Keep in mind that some treatments require the use of a combination of medications. This can drive medication costs even higher.

Who Is Paying?

Private insurance companies, insurance companies that administer state Medicaid and Medicare plans, and the Veterans Administration negotiate drug prices directly with the pharmaceutical manufacturers. They also have their own criteria for who will receive treatment. These criteria may be based on:

  • the severity of liver disease
  • abstinence from alcohol and drug use
  • whether the drug is prescribed by a doctor who specializes in diseases of the liver
  • the life expectancy of the person seeking treatment
  • the viability of using less expensive treatments first
  • the presence of other diseases that contribute to liver damage

Most insurers require pre-authorization for HCV treatments. The authorization process can be extensive. Essentially, you must be sick enough to meet the criteria established by your insurer. As a result, only a small percentage of people are receiving these medications.

What Can You Do?

Remember that you aren’t alone as you seek treatment for your HCV infection. Some people and organizations can help you, including the following:

  • Your doctor, particularly if you’re working with a liver specialist, can help you by ordering and documenting the tests you’ll need so that you can qualify to get your medications.
  • If your insurer denies treatment, you can appeal the decision. Many doctors will provide assistance with this process. Patient advocacy groups can also help with the appeal.
  • Most drug manufacturers have patient assistance programs that offer free or reduced-cost medications for people who meet their criteria.
  • Patient advocacy groups provide assistance with all aspects of HCV treatment.

Where to Find Help Paying for Treatment

Manufacturers’ Patient-Assistance Programs in the United States

Patient Advocacy Resources