Public and private payers currently restrict access to hepatitis C medications, often covering treatment only for people with advanced disease when irreversible damage has already been done. Payers claim they cannot provide access to everyone because hepatitis C drug costs will bankrupt them.
Manufacturers argue they need a high return on investment in successful drugs in order to pay for producing new ones. Some manufacturers note that they offer a blanket percentage discount to all payers and patient assistance programs to expand treatment access. Meanwhile, payers dispute these claims or state that discounts are insufficient.
The job of patient advocates is to ensure that people can access lifesaving medications by urging fair pricing of medications and appropriate coverage by payers. But advocates get caught in the middle of finger pointing between these two parties, both of which expect us to support them. There is no way for us to take an informed position when price negotiations and agreements between manufacturers and public and private payers are confidential. Payers' analyses of costs to their systems do not consider essential factors, including the cost of patients' deteriorating health and productivity, disability or death.
These analyses often overstate costs to taxpayers and the health care system. Fortunately, a recent analysis in Clinical Gastroenterology and Hepatology, "Why We Should Be Willing to Pay for Hepatitis C Treatment," describes the value of hepatitis C treatment, the importance of treating all
hepatitis C patients, and confirms that the total budget for treating hepatitis C is reasonable given its impact on the U.S..
The fight between manufacturers and payers needs to shift to consider the best interests of people with hepatitis C and public health. We have the opportunity to eliminate hepatitis C, an opportunity as great as eliminating polio or the hope of ending HIV.
Manufacturers and payers should not be able to hide negotiations behind confidentiality agreements, especially for public programs. Innovative ways of delivering breakthrough drugs that spread cost equitably between manufacturers and payers need to be developed. Ultimately, people with a life-threatening condition should not have their hopes of cure caught in a fight between manufacturers and payers over profits.