By Marijke Vroomen Durning, RN
The important thing to remember about treatment for hepatitis C (or hep C, also known as HCV, for hepatitis C virus) is that it works; hep C is a treatable virus. Though it may take some time to get on drug therapy, and the therapy itself may last several months, taking these steps can get you closer to the cure you seek. Here are the general milestones in the treatment process:
Treatment for hep C has come a long way. There are now several drug combinations that hep C specialists can use to manage and treat HCV. But as you and your provider discuss a treatment option that may work for you, keep in mind that HCV isn’t a “one size fits all” kind of virus. Instead, there are seven distinct types, known as genotypes. And not all medications or combinations can treat all genotypes. So, one piece of the treatment puzzle is figuring out which HCV genotype is responsible for your hep C infection.
The next piece is taking into account if you’ve been treated before for hep C, or if you’re treatment-naive, which means you’ve never taken medication for the virus.
Besides you treatment history, your hep C specialist will also want to know about any other health problems you may have and which medications you’re already taking (including dietary supplements and other similar products). They may ask questions about your lifestyle, like whether you exercise, drink alcohol or smoke.
Once an initial treatment plan has been determined, your specialist will send the request for the medication to your insurance company. How much time passes before treatment begins depends on how quickly your insurance company makes its decision and what that decision is; it can take up to 4 weeks, or even longer, to get a response, which is sent to both you and your specialist. However, if your specialist regularly treats patients with hepatitis C, their office may be able to speed this up.
When your treatment is approved, the insurer will contact a specialty pharmacy (one that specializes in medications for certain chronic or complex illnesses), which will arrange to deliver the drugs to your requested location. That’s often the doctor’s office, says Hwan Yoo, MD, a liver specialist at Mercy Medical Center in Baltimore, MD.
The drugs used to treat hep C can cost more than $100,000, sometimes as high as $165,000, for a full course, according to Yoo. Because of this high cost, it’s not unusual for an insurance company to reject an initial application for these drugs before approving treatment.
“Most Medicaid insurers have restrictions on the drugs’ access, and may require evidence of significant liver injury before they’ll allow therapy,” explains Mark Mailliard, MD, chief of the gastroenterology and hepatology division at University of Nebraska Medical Center in Omaha.
If your application is rejected, your specialist will probably submit an appeal with more information about your health. You may have to have extra tests, such as an ultrasound scan or a biopsy to check the health of your liver. In cases like these, Maillard recommends persistence: “You want to challenge the system or your insurer to provide the medication that you need,” he says.
Sometimes, an insurance company may refuse to cover the cost of hep C treatment, even after appeal. If you can’t afford to cover the cost of the drugs yourself, there are other options that may work for you, such as payment programs listed by nonprofits like the American Liver Foundation and the Partnership for Prescription Assistance, including patient assistance programs supported by the pharmaceutical companies themselves.
Hep C is a curable illness, and with today’s drugs, achieving a cure is much more likely, because more tolerable medications mean it’s easier to stay on treatment. According to Maillard, he’s seen a 91% cure rate among the last 200 patients he’s treated for hep C. Yoo agrees: “We’re talking about treatment that is very well tolerated, with the more than 90% [of hep C patients] clearing the virus with 8 to 24 weeks of treatment.”
A person is cured of hep C when levels of the virus in the blood are undetectable 3 months after treatment is complete. “There’s a chance of relapse, but if it were to occur, it would always happen within the first 3 months after treatment is finished,” Anurag Maheshwari, MD, also a liver disease specialist at Mercy, explains. The medical term for when someone no longer has the hep C virus is sustained viral response, or SVR.
The length of time it takes to get to SVR depends on a variety of factors, including your viral load, or how much of the virus is present in your body, when you started treatment, the type of medication you’re taking, if there’s any damage to your liver, and how your body responds to the drugs. Some patients take their medications for 3 months (12 weeks) while others may continue treatment for 6 months (24 weeks).
The timeline you’ll follow is called a treatment plan and includes start and end dates for the actual drug therapy, plus a results date 3 months from your end date, when you’ll be tested again for the virus. By following this plan and working closely with your healthcare team, you have an excellent chance of clearing the virus from your body.
Learn more about the treatments currently available for hep C and what lifestyle changes you can make to help your treatment be a success.
Published on March 1, 2016. Updated on April 5, 2017.
Marijke Vroomen Durning, RN, has written articles for numerous healthcare sites and is the author of Just the Right Dose: Your Smart Guide to Prescription Drugs & How to Take Them Safely.
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