BATON ROUGE, La.-For years, Louisiana offered hepatitis C treatment to only the most severe cases in its Medicaid program and prisons, unable to afford broader access to the extremely high-priced medications. That will change in July, when the state begins a treatment model it says can cure tens of thousands who have the infectious, liver-damaging disease.
Louisiana's health department announced Wednesday what it called a "subscription model" deal with Gilead Sciences subsidiary Asegua Therapeutics. Louisiana will pay a flat fee for unlimited access to hepatitis C medication for five years, and will be able to treat as many people as it can, rather than pay a per-patient drug price.
Health Secretary Rebekah Gee celebrated the deal's signing with Gov. John Bel Edwards at a New Orleans health clinic. She said Louisiana hopes to treat 31,000 of the estimated 39,000 Medicaid patients and prisoners with the disease by the end of 2024. By comparison, the state treated about 1,100 people last year, Edwards said.
"It just was unacceptable. We knew we had to do better," said the Democratic governor.
The federal Medicaid agency announced last week that Washington has received approval to use a similar subscription model treatment plan for its hepatitis C patients.
The U.S. Centers for Disease Control and Prevention says hepatitis C, a blood-borne viral infection that can cause liver failure and death, kills more Americans than any other infectious disease. While the CDC says intravenous drug use is the most common method of spreading the disease today, hepatitis C often was spread through the nation's blood supply until 1992.
The medication Louisiana will use has a cure rate of 98% among hepatitis C patients, health officials said. It doesn't take long to work, either. Patients take one pill a day for 12 weeks, said Alexander Billioux, head of the state public health office. The drug co-pay for a Medicaid patient will be no more than $3.
"This is as simple as it can get, very few side effects," Billioux said.
But the cost of treatment per patient is high.
Gee has said a course of the medication can cost about $20,000 to $30,000. The state couldn't afford the estimated $760 million to treat and effective cure everyone in the state's care with hepatitis C under the traditional per-patient model, so health officials three years ago started looking for a different approach.
The payment model Louisiana will use, which Gee has called a "Netflix pricing" approach, has been used in Australia for several years, according to health journals.
Louisiana will pay up to $58 million annually-or up to $290 million-for access to the generic form of the antiviral medication Epclusa, with a portion of the costs covered by federal dollars, according to the health department. That $58 million is the same amount of money the state spent in the current budget year for hepatitis C treatments for prisoners and Medicaid patients.
Unlimited access to the medication will begin July 15, and Billioux said health providers have started reaching out to Medicaid patients to let them know about the available treatment.
"They're already starting to line patients up," he said.
Nikole McArthur, 28, is ready and waiting, after having contracted hepatitis C about a decade ago through IV drug use.
"Knowing that I can now get treatment and live the rest of my life knowing that I'm free of this deadly disease is a wonderful thing," McArthur said.
She described facing a "stigma" as a recovering addict. Gee replied: "No more stigma for anybody, because this is a problem we're going to put behind us."
Officials said treating the state's poorest and most at-risk patients will help combat the spread of the virus.
"We are committed to supporting efforts to eliminate hepatitis C in communities around the world and are excited to partner with the visionary leaders in Louisiana to make this public health opportunity a reality in this state," Gregg Alton, chief patient officer at Gilead Sciences, said in a statement.
The health department didn't immediately release a copy of the contract with Asegua, which Gee said was signed Tuesday night.