United States National Hepatitis C Elimination Initiative
The US Centers for Disease Control and Prevention (CDC) estimates that more than 2 million people in the US are living with hepatitis C. This burden is expected to grow, and despite the availability of effective antiviral therapies, a recent CDC report revealed that only 1 in 3 US adults who had been diagnosed with hepatitis C had been cured. To combat these concerning trends, the White House proposed a National HCV Elimination Plan in their budget for 2023-2034. Supporters of the plan, including CGHE, have mobilized to urge Congress to allocate funds for the program.
The proposed plan has four key components:
- Identify more cases by expanding access to single-visit, rapid results testing
- Expand access to care by eliminating burdensome requirements for people using Medicaid
- Lower costs by establishing a subscription model wherein the government negotiates lump some medications (aka, “Netflix” model)
- Invest in community health programs that are best suited to deliver care while also working to develop a hepatitis C vaccine
Cost and Lives Saved
After a request from the White House, CGHE partnered with Jagpreet Chhatwal at the Institute for Technology Assessment at Massachusetts General Hospital and Harvard Medical School to perform an analysis of the proposed plan to estimate cost and lives saved. This data was used by the Congressional Office of Management and Budget to demonstrate that the national plan to eliminate hepatitis C could save more than 90,000 lives and nearly $60 billion by 2050.
CGHE director John Ward co-authored a “Viewpoint” article in the Journal of the American Medical Association, published in April 2023, arguing that the US must strive to address health disparities in order to achieve elimination of hepatitis C: “Adopting policies that enable access to current approaches to prevention and treatment, although helpful, will not by themselves achieve health equity. We must also prioritize populations disproportionately affected by HBV and HCV, locate low-threshold prevention and care services in settings that serve persons with high disease burden, and ensure that the systems in place to treat infected individuals and care for at-risk populations do more than pay lip service to the social factors influencing health outcomes.”
The Right Thing to Do
CGHE believes that no one should have to suffer or die from hepatitis C. In the United States, one of the wealthiest and most scientifically advanced countries in the world, to see so much loss of life from a curable disease is unconscionable. When Dr.’s Michael Houghton, Harvey Alter and Charles Rice were awarded the Nobel Prize for their discovery of the hepatitis C virus in 2020, they set the stage for a cure that should be accessible to all.
Now they are speaking out in support of a national plan: “At the time of our award, the Nobel Committee recognized the immense potential gains in human health stemming from our discovery of hepatitis C virus and the tests and treatment that followed:
It is now possible, for the first time in human history, to foresee a future where the threat of this virus infection is substantially reduced and hopefully soon eliminated.
We could not agree more. All of the essential ingredients needed to realize the future envisioned by the Nobel Committee are in place save one: a national commitment to eliminate hepatitis C.”
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More about the Proposed U.S. HCV Elimination Plan
The 2024 budget proposed by the White House sets aside $12.3 billion over the next 10 years to eliminate hepatitis C. Right now, as Congress is considering the proposed spending, which would expand testing, increase access to antiviral drugs, and lower the cost of treatment.
Page 79 of the proposed budget explains: “The Budget includes a new mandatory proposal for a national program to significantly expand screening, testing, treatment, prevention, and monitoring of Hepatitis C infections in the United States, with a specific focus on populations with high infection levels. This program would support Federal procurement of life-saving treatments, while bolstering provider capacity and related public health efforts such as testing, communication, and surveillance.
More about Medicaid Restrictions
Restrictions for Medicaid recipients within the U.S. have limited persons living with hepatitis C access to necessary treatments and care. The Center for Health Law and Policy Innovation of Harvard Law School and the National Viral Hepatitis Roundtable (NVHR) have advocated to ensure that all persons in the U.S. living with hepatitis C have access to treatments with the Hepatitis C: State of Medicaid Access Project. Since the start of the project, 21 states no longer require prior authorization for most patients, 33 states have completely removed or limited fibrosis restrictions, 36 states have reduced sobriety restrictions, and 35 states have loosened prescriber restrictions.
Although significant progress has been made towards reducing and/or eliminating Medicaid restrictions, there is still work to be done to ensure a cure for HCV is available to everyone.
Read more on the 2023 National Snapshot Report
CGHE Articles and Media on the U.S. National Plan
- JAMA: Overcome Health Inequities to Eliminate Viral Hepatitis
- NBER: Projected Health Benefits and Health Care Savings from the United States National Hepatitis C Elimination Initiative
- Los Angeles Times: Biden seeks billions to wipe out hepatitis C
- Healio: HCV elimination represents ‘win-win-win’ for patients, public health, cost savings
- PBS: Hepatitis C is ‘not something you wish on anybody.’ Biden has a plan to end it
- Healio: National HCV elimination program a ‘golden opportunity’ to improve lives
More Media on the U.S. National Plan
- CBS: Thousands enroll in program to fight hepatitis C: "This is a silent killer"
- Louisiana Dept of Health: Over 11,000 Louisiana Residents Have Accessed hepatitis C life-saving medication
- Stat News: With a promising new plan to pay for pricey cures, two states set out to eliminate hepatitis C. But cost hasn’t been the biggest problem
- The Lancet: A US Plan for HCV elimination
- Science: White House budget includes ambitious push to eliminate hepatitis C
- JAMA: A National Hepatitis C Elimination Program in the United States: A Historic Opportunity
- LSU Health: Hepatitis C Elimination Program
- Johns Hopkins: Hepatitis C Testing and Treatment in Louisiana: A Model for National Hepatitis C Elimination through Corrections
- Texas HHS: Feasibility and CostEffectiveness of CrossAgency Bulk Purchasing for Direct Acting Antiviral Medications for Hepatitis C
- Georgetown: Looking Beyond Innovative Payment Models for Hepatitis C Virus Elimination
- JAMA: Medicaid Subscription-Based Payment Models and Implications for Access to Hepatitis C Medications
- Rand: Subscription Models for Prescription Drugs
- NIH: The Payer License Agreement, or “Netflix model,” for hepatitis C virus therapies enables universal treatment access, lowers costs and incentivizes innovation and competition
- US HHS: Payment and Reimbursement Models for Integrated Hepatitis C Services Preliminary Findings from a Comprehensive Environmental Scan