Louisiana May Deploy Subscription Payment Model to Expand Hepatitis C Treatments

The Louisiana Department of Health (LDH) has published 13 responses to its ‘request for comments’ regarding a proposed ‘subscription-model’ for treating people with hepatitis C. 

This innovative business model would ‘enable the state to dramatically expand access to expensive direct-acting antivirals with the goal of eventually eliminating Hepatitis C as a public health problem,’ LDH said in a statement.   

The high cost of these drugs prohibits the state from providing treatment to larger numbers of Medicaid patients and incarcerated individuals. 

About 30,000 people in Louisiana's Medicaid program and prison system are carrying Hepatitis C. 

But, less than 3 percent of Louisiana’s Medicaid beneficiaries received hepatitis C treatment during 2017, said LDH. 

Hepatitis C is a viral disease that causes inflammation of the liver that kills the most people annually, and rates of new infections are growing dramatically as a result of the opioid epidemic, said LDH. 

“A successful subscription-based model would create an incentive for us to find and treat as many people as possible,” said Dr. Rebekah Gee, secretary of the Louisiana Department of Health.

“For the drug manufacturer, this model would guarantee a fixed purchase price for a contracted period of time, and would allow the drug manufacturer to expand their product reach into populations that otherwise would not have received treatment.” 

To treat and effectively cure everyone in the state’s care with hepatitis C would total around $760 million, Dr. Gee said to AP News.   

“I have a $760 million problem, and I have $35 million to invest,” she said. “In my view, we can’t solve this equation as it is today.” 

“We have to rewrite the equation,” Dr. Gee said. 

Under this at-risk payment model, the state would pay a drug manufacturer or manufacturers for unlimited access to the treatment for the individuals in Louisiana who are enrolled in Medicaid or in Louisiana’s correctional system. 

The payment to the manufacturer would be equal to or less than what the state is currently spending to provide the antiviral medication to these populations. 

One of the 13 submitted responses was from Gilead Sciences, Inc., who said:

• Such a creative model “could create predictable expenditures for the state while ensuring broad access as part of a [hepatitis C virus] elimination strategy.”
• Gilead pointed out the cost-effectiveness of this model to Medicaid, the potential for future savings to Medicare and other payors, and supported including people who are incarcerated.

For questions or to submit a late response to the Department's Request for Information, contact Pete Croughan at [email protected] with “HCV RFI” in the subject line. The deadline for comments was August 24, 2018. The complete Request for Information can be found here. 

The next step is for Louisiana to develop the subscription model in greater detail with the Centers for Medicaid and Medicare Services (CMS). If waivers under the Medicaid program are required, these will be posted for public comment before submission to CMS.

At this time, there is not an FDA-approved preventive vaccine available for Hepatitis C but, there are vaccine candidates in clinical trials.