Although 90 percent of people can be cured with 8 to 12 weeks of therapy, according to the Centers for Disease Control and Prevention (CDC), many people living with the virus have difficulty getting treatment. In particular, treatment options remain limited among marginalized communities, says Walid S. Ayoub, MD, associate medical director of liver transplantation at Cedars-Sinai Comprehensive Transplant Center in Los Angeles. This is especially true for people who inject drugs (PWID), because they are especially vulnerable to contracting the virus. (Hepatitis C is primarily spread through infected blood.) Here are some of the barriers surrounding access to hepatitis C treatment.
Medicaid Requirements Can Prevent Coverage for Hepatitis C
In recent years, Medicaid — the national public health insurance program for people with low income — has limited their approval of hepatitis C treatments to people who meet strict behavioral criteria, including drug and alcohol restrictions. Some states now require Medicaid recipients to be clean for anywhere from six months to one year. These restrictions can block access to potentially life-saving hepatitis C medications for people who currently use drugs or alcohol. The strict criteria to qualify for Medicaid coverage — implemented to reduce spending, says Dr. Ayoub — is devastating for people with hepatitis C who are struggling with addiction. It has come with “major ethical concerns and a significant potential for a public health crisis,” he says. Not only do people want to treat their condition, Ayoub says, but they also don’t want to harm others by giving them the virus. (In 13 states, it can actually be illegal to engage in behaviors where you might pass hepatitis C on to another person — regardless of whether you actually transmit the virus! This, despite the fact that a few of these same states don’t allow needle exchange programs, which provide new and sterile needles to PWID in an effort to help stop the spread of the virus.) Importantly, there is no evidence linking sobriety to faster or improved recovery from the virus, according to the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America. What’s more, a study published in June 2017 in the American Journal of Public Health found that PWID stick to their antiviral treatment regimens as much as people who don’t inject drugs. The same study ultimately concluded that decision makers should reject these coverage restrictions and instead explore policy strategies that could balance budgetary goals and provide efficient treatment, which would further prevent the spread of the virus.
Other Barriers to Hepatitis C Treatment
Medicaid’s restrictions aren’t the only barrier to receiving accessible hepatitis C treatment. Although Black Americans are about as likely to inject drugs as white Americans, according to a study published in the American Journal of Public Health, Black people are more likely to share needles due to limited access to needle exchange programs. So it should come as no surprise that Black Americans also have higher rates of infection and hepatitis C–related death compared with the overall population, according to the U.S. Department of Health and Human Services Office of Minority Health. The Black and Latinx communities also have the highest rates of households without health insurance, according to a report on insurance coverage during the first six months of 2021 by the CDC. Paying out of pocket for hepatitis C treatment, which can cost tens of thousands of dollars, is not an option for many people who are uninsured, are on Medicaid, or cannot meet the drug and alcohol requirements. Plus, not everyone is being routinely screened for hepatitis C. According to the HHS report, about half of people who have the virus don’t know they’ve been infected with it, so they aren’t receiving treatment. The CDC recommends that every adult be screened for hepatitis C at least once; others, including PWID, need to be screened more routinely. Ayoub also points out that some providers aren’t familiar with new treatments. A study published in December 2016 in the journal Digestive Diseases and Sciences found that 70 percent of primary care physicians did not feel adequately knowledgeable about hepatitis C treatment, and 71 percent referred their patients who had been diagnosed with the virus to a specialist. There’s also a lack of education about the virus among the general population, according to Ayoub, as well as concerns regarding confidentiality. Stigmas around contracting the virus and injecting drugs create even more self-imposed barriers that can prevent people from seeking a diagnosis or treatment.
