Fewer people have received the critical drug for hepatitis C under Medi-Cal in recent years, troubling advocates who have pushed to expand the life-saving treatment.
Hepatitis C, a slow-moving virus that can cause liver cancer, cirrhosis and death, can now be cured in most cases with a few months of direct-acting antiviral medication. California has taken steps to remove barriers to obtaining the pills under Medi-Cal, the California Medicaid program, including eliminating requirements for prior authorization.
Yet, the number of Medi-Cal patients receiving annual prescriptions declined by more than 40% between fiscal years 2018-19 and 2020-21, according to data provided to the Times by the California Department of Health Care Services. According to The number remained flat the following year, hovering at around 5,500 patients, and appears to have picked up again this budget year.
State officials could not say for sure why this happened, but said the decline was in line with national trends during the COVID-19 pandemic, as fewer people tested positive for the virus and many patients avoided healthcare .
California’s Department of Public Health also stated that as time passed after newer, more effective drugs for hepatitis C became available, physicians reported that the most easily accessible patients were already treated, and ” Those who remain untreated are the ones with the highest barriers to treatment.”
The Department of Health Care Services, which administers Medi-Cal, said it is continuing to review the data “to better understand potential barriers to care.”
DHCS “understands that timely initiation of treatment is critical to reducing mortality, disparities, and transmission, and to encourage improvements in treatment rates for Medi-Cal patients, education of Medi-Cal providers on available treatment options And will continue to provide outreach.”
DHCS said it’s unclear how many Medi-Cal patients may be going without needed treatment. In the past, researchers have estimated that more than 300,000 people in California are living with hepatitis C, and a state report found that there were more than 35,000 cases of chronic hepatitis C in 2018.
Those statewide figures are not limited to Medi-Cal enrollees, who are estimated to be about one-third of the state’s population. But in light of those numbers, some experts were dismayed to see fewer than 6,000 patients in the Medi-Cal program receiving direct-acting antiviral drugs annually in recent years.
“We’re not treating enough people,” said Dr. Christian Ramers, an infectious disease specialist and chief of population health at Family Health Centers of San Diego. He blamed gaps in testing, connecting people to treatment and not enough physicians providing care. “There hasn’t been a real, concerted effort to make hepatitis C treatment an easily accessible part of primary care.”
Los Angeles County also saw a decline in hepatitis C treatment: prescriptions for the pills filled at retail pharmacies dropped by nearly 58% between 2019 and 2021, according to an unpublished analysis by researchers at USC and the LA County Department of Public Health Has come The numbers increased somewhat in 2022, but remained well under pre-pandemic levels.
Recent increases in L.A. County and across the state are encouraging, but “there are now a lot of people who have given up on treatment over the last three years of the epidemic and no one is reaching them,” said Dr. Jeffrey Klausner, who author of the analysis.
Klausner, clinical professor of medicine, population and public health sciences at USC’s Keck School of Medicine, said that “we never had the same established approach with hepatitis C as we have for other infectious diseases, where We reach out to people to make sure they get treated. … Someone with untreated hepatitis is at risk of spreading hepatitis to other people.
Researchers have found that only a fraction of people infected with hepatitis C immediately begin treatment in the United States. Many people are unaware that they have it. Experts blame constraints on some insurance programs, underinvestment by public agencies, complications in the process of obtaining the drug, and hesitancy among primary care physicians, among other barriers.
Some Medicaid programs in other states still require patients to have minimal liver scarring before starting treatment or abstinence to receive the pills, which was the case when they first came on the market. So very expensive were and remain expensive for many public events. California eliminated such requirements to ease access, but experts said it is still hard for many patients to connect to the care they need.
“California has been very proactive in lowering the barriers. … From an insurance perspective, there’s really no reason why people shouldn’t be able to get treatment under Medi-Cal”, Los Angeles County Department of Public Health Viral Dr. Prabhu Gounder, Medical Director, Hepatitis and Respiratory Diseases Unit, said Health. Instead, “It’s these other issues.”
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Anne Donnelly, co-chair of the California Hepatitis Alliance, said that “we’re seeing the most dramatic new increase in people with a lot of barriers to accessing healthcare,” including people who use drugs through shared needles. may become infected. “It’s very difficult to reach people with hepatitis C with the limited resources we have.”
California’s Department of Public Health said it is funding 22 local health jurisdictions to offer testing, treatment and other services to the most vulnerable and underserved patients with hepatitis C, including in “non-traditional settings” such as Drug treatment programs, mobile health vans are included. , street outreach and syringe service programs. The department is also promoting routine, opt-out testing for hepatitis C and other viral diseases in emergency departments to ensure that more people know their status and receive treatment.
UCLA Health has a rolling clinic that is part of a study assessing the effectiveness of a one-stop unit to link people who inject drugs to health services, including hepatitis C treatment. Klausner said USC and the LA County Department of Public Health are working on an effort to bring the treatment directly to patients, which could begin later this year.
When the Department of Public Health learns that someone is infected, Klausner said, it “will mail you the medicine. Uber a package. Deliver the medicine directly to you. They can meet you at your work. If you’re not home , then this might be where you’re staying.”
And Ramers said he was encouraged to see that Dr. Francis Collins, former director of the National Institutes of Health and a special projects advisor to President Biden, is working on a national initiative to combat hepatitis C.
Donnelly said that as a slow killer, hepatitis C is often not treated as an emergency, “despite how terrible it is and how much it costs the health care system and how many lives it ruins.” does and how many people it kills.”
It’s not like “the big tsunami you can see,” Donnelly said. “This is the bottom of the iceberg.”