New Heptatitis-C Drugs Now Available to All Veterans Who Need It
In a past articles we have written about the current abortion of a program known as Veterans Choice which Congress itself helped to create in trying to make the VA’s healthcare system more responsive to veterans living in the current era (In the coming year we should expect to see major improvement.) Ironically, an immediate good has resulted from this failure because funds were transferred from the program to overcome a critical budgetary crisis, partially caused by the cost of a certain breakthrough, hepatitis drug. Furthermore, the issue of hepatitis care was not then forgotten. This is important news to those among the estimated 200,000 veterans who heretofore have been awaiting the lifesaving medicine now available – sofosbuvir, sold as Sovaldi and Harvoni.
On 9 March 2016, the Department of Veterans Affairs (VA) announced that it was now able to fund care for all Veterans with Hepatitis C for Fiscal Year 2016 regardless of the stage of the patient’s liver disease. In it, the VA merely states the move follows increased funding from Congress along with reduced drug prices. H.R.2029, the Consolidated Appropriations Act of 2016, became law on 18 December 2015 as PL 114-113. As a result, no longer will lack of funds require treatment priority going to the sickest patients. Additionally, if a veteran is awaiting an appointment for community care through the Choice Program, the person ” … can now turn to their local VA facility for this treatment or can elect to continue to receive treatment through the Choice Program.”
Last year hepatitis C drugs used 17 percent of the VA’s total pharmacy budget. The VA expects to spend approximately $1 billion (about $700 million was spent last year) on hepatitis C drugs this fiscal year, but more veterans will also be helped.
Earlier, on 26 February, the National Association of the Uniformed Services (NAUS) received a copy of a VA memorandum outlining the expansion of medical coverage for the treatment of Hepatitis C.1 It provides more details than the VA’s press release. The Memorandum for Record, dated 24 February 2016, reads:
In follow-up to the January 27, 2016 memorandum from the Acting Deputy Under Secretary for Health for Operations and Management, this memorandum provides updated information regarding Hepatitis C Virus (HCV) funding and prioritization. Please share this memorandum expeditiously with facility leadership and Chiefs of Pharmacy. Expansion of eligibility for HCV treatment within VA:
Effective immediately, for the remainder of FY 2016, all Veterans with HCV may receive treatment within VA facilities without regard to stage of liver disease; the use of the prioritization protocol to determine eligibility for treatment within VA is no longer in effect. We have received funding from Congress to support a more aggressive roll-out for treatment of Veterans who are infected with HCV.
Even though we are not limiting treatments, facilities should manage resources to ensure that patients with more advanced disease receive treatment as soon as possible and continue outreach to such patients to offer them treatment.
Facility managers should take immediate steps to ramp up treatment to the maximum possible capacity. Managers should ensure that adequate clinical resources (staffing, clinical pharmacists, laboratory testing, psychosocial support, etc.) are allocated to clinics providing HCV treatment to allow full utilization of funding for HCV treatment.
At this time, funding for HCV treatment may only be used for drug acquisition. We have not received additional funding for staffing or laboratory testing.
Veterans who have been offered HCV treatment through Choice but have not yet seen a Choice HCV provider, may elect, at the Veteran’s discretion, to receive treatment at a VA facility or to continue the referral to the Choice HCV provider.
However, there is more to this story than a mere transfer of funds from one account to another to relieve a problem and then additional funding from Congress the following year — and a reduction of drug prices. Beyond questions about how good the VA is at budgeting (there have been problems in the past), there is also a story in the background about individual ethics and corporate profiteering. On 1 December, “… a Senate report found Gilead Sciences, which makes a cure for a fatal form of hepatitis, is more interested in profits than patients. In addition, the cure was found under the leadership of a celebrated doctor in the Department of Veterans Affairs seeking to make a profit while working as a private researcher. The end result: a $1,000 lifesaving pill even the VA couldn’t afford until the deal was struck.2
Maybe we should be hearing more about how to prevent such future occurrences which affect lives.
1 – NAUS Weekly Update, 25 February 2016
2 – “VA Can’t Afford Drug for Veteran Suffering from Hepatitis C”, Chip Reid, CBS News, December 1, 2015, 7:23 PM < http://www.cbsnews.com/news/va-cant-afford-drug-for-veterans-suffering-from-hepatitis-c/>
As of 18 March 2016