Hepatitis C can be cured. So why aren’t there more people getting treatment?

Ten years ago, safe and effective treatments for hepatitis C became available.

These pills are easy to take oral antivirals with few side effects. They cure 95% of the patients who take them. The treatments are also expensive, running at $20 to $25,000 a course.

A new report from the Centers for Disease Control and Prevention finds that the high cost of drugs, coupled with coverage restrictions imposed by insurers, have kept many people diagnosed with hepatitis C from accessing curative treatments over the past decade.

The CDC estimates that 2.4 million people in the United States are living with hepatitis C, a liver disease caused by a virus that is spread through contact with the blood of an infected person. Currently, the most common route of infection in the United States is through sharing needles and syringes used for injecting drugs. It can also be transmitted through sex and childbirth. If left untreated, it can cause severe liver damage and liver cancer, and causes about 15,000 deaths in the United States each year.

“We have the tools … to eliminate hepatitis C in our country,” says Dr. Carolyn Wester, director of the CDC’s Division of Viral Hepatitis. “It’s about having the will as a society to make sure these resources are available to all populations with hepatitis C.”

High costs and insurance restrictions limit access

According to the CDC’s analysis, only 34 percent of people known to have hepatitis C in the past decade have been cured or cleared of the virus. Nearly one million people in the United States live with undiagnosed hepatitis C. Of those diagnosed with hepatitis C in the past decade, more than half a million have not had access to treatment.

The drug’s high cost has led insurers to put “stumbling blocks in the way of people and their doctors,” Wester says. Some commercial insurance providers and state Medicaid programs will not allow patients to get the drug until they see a specialist, abstain from drug use, or reach advanced stage liver disease.

“These restrictions are not in line with medical guidelines,” Wester says, “The national recommendation for the treatment of hepatitis C is that everyone who has hepatitis C should be treated.”

To address the languishing acceptance of hepatitis C treatment, the Biden administration has proposed a nationwide hepatitis C elimination program, spearheaded by Dr. Francis Collins, former director of the National Institutes of Health.

“The program will prevent cases of liver cancer and liver failure. It will save thousands of lives. And it will more than pay off in future reductions in health care costs,” Collins said, in a CDC conference call with reporters Thursday.

The plan proposes a subscription model to increase access to hepatitis C drugs, in which the government would negotiate with drugmakers to agree on a flat-rate payment, “and then make the drugs freely available to anyone on Medicaid, who it’s not insured, who’s in the prison system or on a Native American reservation,” says Collins, adding that this model for hepatitis C drugs has been successfully tested in Louisiana.

The $11.3 billion five-year program is currently under consideration in Congress.