The Hep C Cure Subscription

February 1, 2019

Monthly subscription for streaming music?  Sure. Unlimited gym access? Of course. Favorite Netflix shows?  Yep. But hepatitis C treatment by subscription?

Maybe so.

In the state of Louisiana, officials recently released a solicitation seeking a fixed price for an “unrestricted supply” of the direct-acting antivirals that can cure hepatitis C.  A subscription, if you will. Having spent $35 million last year to treat fewer than 1,200 patients, the state is taking a new approach.  

The proposed subscription would allow Louisiana to cap spending on the drugs.  It would also incentivize the winning bidder to treat as many patients as possible, according to the state.  Meanwhile, Louisiana officials have their own treatment goal: Cure 10,000 people by 2020. That’s almost a quarter of the 39,000 people with hepatitis C covered by Medicaid or in Louisiana state prisons.

And Louisiana’s idea may be catching on.  Washington state followed up with a Netflix-style subscription solicitation of its own this month.

While these states deserve credit for proposing a novel payment model, a few questions remain:

  • Which patients will receive treatment first?  Many state Medicaid programs, including Louisiana, have a record of imposing restrictive criteria to keep patients from direct-acting antivirals.  Louisiana previously earned an “F” because it required patients to demonstrate advanced liver damage and meet sobriety requirements.  It also limited which specialists could prescribe the medicine.

 

  • What’s the plan to expand provider capacity?  Treating thousands more patients will require additional doctors.  And don’t forget additional clinical staff to draw labs and complete patient follow up.  While the solicitation notes the state wants to train primary care providers to diagnose and treat hepatitis C, it’s been mum on the plans for such an expansion.

 

  • What about treatment choice?  Several different hepatitis C cures exist, and they vary in which patient genotypes they treat and what side effects they may present. Some are used in combination with other therapies.  It’s unclear how many contracts the states plan to award, but the possibility of having a single provider raises concerns. That could mean fewer choices for patients and less decision-making power for physicians.  While widespread treatment is critical, decisions among medicines belong with a physician and his or her patient, not the state.

 

Finding viable answers to these questions could free Louisiana, Washington and perhaps other states to follow through with their innovative plan.  

In an age where subscriptions serve everyday needs from grocery delivery to online news access, patients and policymakers alike are eager to see it serve a deeper purpose: curative treatment for a chronic and deadly disease that continues to threaten public health.  

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