New cases of hepatitis C infections nearly tripled from 2010 to 2015, but just three states have laws and Medicaid policies aimed at stemming the spread of the virus and increasing access to treatment, according to a pair of CDC reports published Thursday.
What providers can learn from the drug pricing debate
Details of the reports
In one report, CDC used case reports from 40 state health departments in the United States to estimate the total number of new cases of hepatitis C in 2015. CDC compared the 2015 estimate to a previous estimate from the agency for 2010.
In the other report, CDC conducted a state-by-state analysis of laws that can affect access to hepatitis C treatment and needle exchange programs to examine the influence of state laws on hepatitis C rates.
Findings on hepatitis C rates
CDC said the number of confirmed hepatitis C case reports it received rose from 850 in 2010 to 2,436 in 2015. However, the agency said nearly half of the people who are infected with the virus do not know they have it—and most new infections go undiagnosed—which means the reported cases do not reflect the true scale of hepatitis C rates. CDC estimated that nearly 34,000 new hepatitis C infections actually emerged in the country in 2015.
New hepatitis C infections emerged most rapidly among U.S. residents ages 20 to 29, which CDC attributed to rising use of injectable drugs associated with the country's opioid misuse epidemic.
Still, CDC said three-quarters of the 3.5 million U.S. residents who were infected with hepatitis C in 2015 were baby boomers, who were born between 1945 and 1965 and were six times more likely to be infected with the virus than those in other age groups.
In addition, CDC found that nearly 20,000 U.S. residents died from hepatitis C in 2015, but that those numbers appeared unchanged in recent years because of a push to test all baby boomers for the virus and treatment improvements.
Findings on state laws related to hepatitis C rates
In the second report, CDC found that one of the best ways for states to prevent the spread of the virus is by implementing public health laws that:
- Allow access to clean needles for drug users, such as needle exchange programs;
- Allow retail stores to sell needles without prescriptions; and
- Decriminalize the possession of needles.
According to the report, only Massachusetts, New Mexico, and Washington have both public health laws and a Medicaid policies that could help prevent the spread of hepatitis C and provide treatment services for individuals who inject drugs.
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CDC found 18 states had no programs to offer individuals clean needles or decriminalize syringe use. However, the agency noted that three states—Maine, Nevada, and Utah—had the most comprehensive laws to prevent the spread of hepatitis C, including statewide needle exchange programs.
CDC also found that states' Medicaid policies could hinder access to care. For instance, the agency found 24 states require individuals to have a period of sobriety before they can receive a hepatitis C curative treatment through Medicaid.
The agency noted that while the cost of hepatitis C treatments "have raised budgetary issues for state Medicaid programs in the past, the costs of HCV treatment have declined in recent years, increasing the cost-effectiveness of treatment."
John Ward, director of CDC's Division of Viral Hepatitis, said, "We have a cure for this disease and the tools to prevent new infections. Now we need a substantial, focused, and concerted national effort to implement … [them] and make effective prevention tools and curative treatment available to Americans in need."
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Jonathan Mermin—director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention—said there should be more "testing, curing, and preventing hepatitis C … [to] protect generations of Americans from … death." Mermin added that the hardest-hit communities need access to a range of prevention and treatment services, including services that prevent the misuse of prescription drugs and diagnose hepatitis C infections.
Daniel Raymond, policy director for the national Harm Reduction Coalition, said the best way to prevent the spread of hepatitis C is through needle exchange programs, because hepatitis C is commonly spread when drug users share their needles and other equipment. He added that people who are pricked with discarded needles, such as emergency responders, also can contract the virus.
Jonathan Gruber, a former health care consultant for former President Barack Obama's administration and an economics professor at Massachusetts Institute of Technology, said investing in treatment options not only cures the vast majority of infections, but also prevents the transmission of the hepatitis C infection to others (Stobbe, AP/Sacramento Bee, 5/11; Berkrot, Reuters, 5/11; O'Donnell/DeMio, USA Today, 5/11; CDC press release, 5/11; CDC report on viral hepatitis; 5/11; CDC report on state policies, 5/11).
What providers can learn from the drug pricing debate
We already knew that patients are becoming more sensitive to health care costs. But public uproar over one drug's 5,000 percent "overnight" price hike proves that patients are more discerning—and vocal—than ever. With more of their money on the line, patients are actively deciding when and where to access care based on cost.
We saw it coming—and we laid out concrete tactics for dealing with price sensitivity in your market. The first chapter in our study, The Consumer-Oriented Ambulatory Network, focuses on how you can retain market share by making services more affordable. Download the study to learn more.