Fewer Medi-Cal patients received treatment for hepatitis C amid COVID
Fewer people have received critical hepatitis C drugs through Medi-Cal in recent years, troubling advocates who have pushed for lifesaving treatment to be expanded.
Hepatitis C, a slow virus that can lead to liver cancer, cirrhosis and death, can now be cured in most cases with a few months of direct-acting antiviral drugs. California has taken steps to remove barriers to obtaining the pills under Medi-Cal, California’s Medicaid program, including removing prior authorization requirements.
Still, the number of Medi-Cal patients receiving the drugs declined more than 40% each year between fiscal years 2018-19 and 2020-21, according to data provided to The Times by the California Department of Health Care Services. The number remained stable the following year, hovering around 5,500 patients, and appears to have begun to recover in that fiscal year.
State officials couldn’t say for sure why this happened, but said the drop was in line with national trends during the COVID-19 pandemic as fewer people were tested for the virus. and many patients avoid healthcare.
The California Department of Public Health also said that as time has gone on since newer, more effective hepatitis C drugs have become available, clinicians have reported that patients who are most easily reached may have already been treated and that “those who remain untreated have the most barriers to treatment.
The Department of Health Services, which manages Medi-Cal, said it continues to review the data “to better understand potential barriers to care.”
The DHCS “understands that early treatment initiation is critical to reducing mortality, inequities and transmission, and will continue to provide education and outreach to Medi-Cal providers about available treatment options to encourage improvement. ” treatment rates for Medi-Cal patients,” he said.
It’s unclear how many Medi-Cal patients could go without needed treatment, the DHCS said. In the past, researchers estimated that more than 300,000 people lived with hepatitis C in California, and a state report found that more than 35,000 cases of chronic hepatitis C were reported in 2018.
These statewide numbers are not limited to Medi-Cal enrollees, who would make up about one-third of the state’s population. But in light of those numbers, some experts were disappointed to see that fewer than 6,000 Medi-Cal program patients received the direct-acting antivirals each year for the past several years.
“We’re just not treating enough people,” says Dr. Christian Ramers, an infectious disease specialist and chief of public health at San Diego Family Health Centers. He criticized gaps in testing, connecting people to treatment, and having enough clinicians to provide care. “There just hasn’t been a real, concerted effort to make hepatitis C treatment an easily accessible part of primary care.”
Los Angeles County has also seen a decline in hepatitis C treatment: Prescriptions for pills filled at pharmacies fell nearly 58% between 2019 and 2021, according to an unpublished analysis by researchers at USC and the LA County Department of Health. Public Health. The number increased slightly in 2022, but remained well below pre-pandemic levels.
The recent uptick in LA County and across the state is encouraging, but “there are now a lot of people over the past three years of the pandemic who have declined treatment and no one is reaching out to them,” said Dr. Jeffrey Klausner, one of the authors of this analysis.
Klausner, clinical professor of medicine, population sciences and public health at USC’s Keck School of Medicine, complained that “we’ve never implemented the approach with hepatitis C the way we’ve done it for other infectious diseases, where we’ve reached out to people to make sure get them treated… Someone who is not being treated for hepatitis is at risk of passing hepatitis to others.
Only a fraction of hepatitis C-infected people begin treatment early in the United States, researchers say. Many don’t know they have it. Experts have criticized barriers in some insurance programs, low investment by public agencies, complications in obtaining medications and hesitation by primary care physicians, among other obstacles.
Some Medicaid programs in other states still require patients to have minimal liver scarring before starting treatment or impose fasting requirements to get the pills, which were extremely expensive when they came on the market and remain so. costly for many public programs. California removed those requirements to ease access, but experts said it was still difficult for many patients to connect to the care they needed.
“California has been very proactive in removing barriers. … From an insurance perspective, there really is no reason why people shouldn’t be treated” under Medi-Cal, said Dr. Prabhu Gounder, medical director of the Viral Hepatitis and Respiratory Disease Unit at the Los Angeles County Department of Public Affairs. Health. Instead, “it’s those other issues.”
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Anne Donnelly, co-chair of the California Hepatitis Alliance, said: “We are seeing the most dramatic new increase in the number of people facing many barriers to accessing health care,” including people who use drugs, who may have been infected by shared needles . “It’s very, very difficult to reach people with the limited resources we have for hepatitis C.”
The California Department of Public Health said it is funding 22 local health jurisdictions to provide testing, treatment and other services to the most vulnerable and underserved patients with hepatitis C, including in “non-traditional settings,” such as drug treatment programs, mobile health vans. , outreach programs and needle services. The department has also promoted routine opt-out testing for hepatitis C and other viral illnesses in emergency departments to ensure more people know their status and receive treatment.
UCLA Health has a mobile clinic that is part of a study examining the effectiveness of a one-stop unit for connecting people who inject drugs with health services, including treatment for hepatitis C. Klausner said USC and the LA County Public Health Department working together to bring treatment directly to patients, which could be launched later this year.
If the public health department finds out someone is infected, Klausner said, “they will send the drug to you. Uber a package. Deliver the medicine directly to you. Maybe they meet you at work. If you are not housed, this may be where you stay.
And Ramers said he was encouraged to see Dr. Francis Collins, former director of the National Institutes of Health and special projects advisor to President Biden, was working on a national initiative to fight hepatitis C.
Donnelly said hepatitis C, as a slow killer, is often not treated as an emergency, “despite the horror and the health care costs and the number of lives it destroys and the number of people it kills.”
It’s not like “the big tsunami you can see,” Donnelly said. “It’s the bottom of the iceberg.”
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