More teachers and state employees with hepatitis-C will be eligible for treatment with expensive drugs under changes adopted by a state board on Tuesday.
The changes approved by the State and Public School Life and Health Insurance Board broadened criteria for the treatment that the board set just over a month ago for coverage of the drugs, which can cost more than $86,000 for a 12-week course of treatment.
The changes will also allow most patients who meet the criteria to take a drug regimen that does not involve injections of interferon, which can cause flulike side effects.
The changes were recommended by the board's Drug Utilization and Evaluation Committee on April 6 after Jill Johnson, an associate pharmacy professor at the University of Arkansas for Medical Sciences, met with Andres Duarte-Rojo, director of UAMS' Viral Hepatitis Clinic, to get his opinion on the policy adopted by the board in March.
Johnson advises the board as part of the UAMS College of Pharmacy's Evidence-Based Prescription Drug Program.
"This is better," board member Andrew Kumpuris, a Little Rock cardiologist, said at the meeting Tuesday. "It's more balanced."
But Kumpuris said he was concerned that the policy would exclude from coverage those who previously started treatment but didn't finish it, unless the failure to finish the treatment was because of a patient's inability to tolerate a certain drug.
"You're putting somebody in a very difficult position to make that determination" on whether a patient who didn't finish an initial course of treatment would be eligible for a second course, Kumpuris said.
Duarte-Rojo, reached by phone after the meeting, said the changes made the coverage policy better, although not ideal.
"The ideal is that if you are a good candidate for having anti-viral therapy, and you want anti-viral therapy, you should be treated," he said.
The changes affect plans covering about 147,000 people, including 45,000 school employees, 28,000 state employees and retirees and family members of employees and retirees.
The cost of hepatitis-C drugs concerns insurers because more than 3 million people nationwide, including about 38,000 in Arkansas, are estimated to be infected with the disease.
Dwight Davis, director of the Evidence-Based Prescription Drug Program, told members of a legislative task force monitoring the teacher and state employee plans earlier Tuesday that many people with the disease don't know they have it.
Treating just 0.5 percent of those covered by the school employees and state employee plans -- about 735 people -- would cost about $64 million, he said.
By comparison, the plans' annual spending on all prescription drugs totals about $117 million, he said.
"That eats up a huge portion of that," Davis said.
In August, the health insurance board approved coverage of Sovaldi, manufactured by Gilead Sciences of Foster City, Calif., and approved by the U.S. Food and Drug Administration in December 2013. For patients with the most common type of hepatitis-C, however, the coverage was restricted to those with cirrhosis, the most severe form of liver scarring, who are on a waiting list for a liver transplant.
The board also restricted coverage for any treatment to patients with liver scarring, known as fibrosis, significant enough to be rated at least an F3 under a scoring system that rates scarring on a scale of F0 to F4.
A score of F4 means the patient has cirrhosis.
In March, the board broadened the coverage criteria for Sovaldi and added coverage of Harvoni, also manufactured by Gilead, and Viekira Pak, a two-pill combination manufactured by North Chicago, Ill.-based AbbVie Inc. Both drugs were approved by the FDA last year.
The changes approved Tuesday extended coverage to patients who experience certain complications from the disease, known as "extrahepatic manifestations," regardless of their degree of liver scarring.
The policy also will no longer exclude from treatment those who have hepatitis-C as well as liver disease caused by alcohol consumption or another condition, such as chronic hepatitis-B.
Such patients will be eligible for treatment if they are referred to a gastroenterolgist.
Davis said the plans so far have only approved one request for coverage of one of the new drugs.
That request, for Viekira Pak, was initially denied, but the denial was reversed after the patient filed an appeal and provided additional information, Davis said.
The denial of 14 other requests have been upheld on appeal, he said.
Mike Galbraith, a history teacher and volleyball coach at Rogers High School who was diagnosed with hepatitis-C about a year ago, called the changes "very, very encouraging."
Although his fibrosis score is only F1, Galbraith said he suspects the disease is the cause of his "overwhelming fatigue," as well as severe indigestion that often keeps him awake at night. His doctor prescribed Harvoni, but the health plan denied coverage because the drug had not been approved by the board.
Galbraith said he expects his doctor will write another prescription for the drug when he goes for a visit next month, and he's hopeful that the plan will cover it.
"The state is a big, ponderous beast," Galbraith said. "This has been a frustrating year of dealing with them, but a lot of things are happening."
Metro on 04/22/2015
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