2017 HHS Consultation

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Report from an Expert Consultation on the Evidence for Early Treatment of HCV in the United States

February 3, 2017

Full Meeting Report

By: Richard Wolitski, Ph.D., Director, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services and Corinna Dan, R.N., M.P.H., Viral Hepatitis Policy Advisor, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services

In September 2016 HHS hosted a multi-stakeholder meeting, Expert Consultation on the Evidence for Early Hepatitis C Treatment in the United States to identify barriers to accessing hepatitis C treatment and potential strategies for ensuring that people who are infected can get the recommended treatment. This meeting focused specifically on the perspectives, data, and experiences that inform health care policies and practices. It did not tackle the issues, perspectives, and experiences of the pharmaceutical industry. A total of 34 healthcare experts participated including payers, academic researchers, hepatitis advocates, and federal partners.

While several treatments that cure over 90% of individuals with hepatitis C virus (HCV) are now available, a host of challenges and data gaps exist that pose barriers to expanding care to all those in need of treatment. The two-day consultation featured presentations and facilitated discussion on topics including:

  • The cost and benefits of early HCV treatment,
  • Barriers to accessing HCV direct-acting antiviral agents (DAAs),
  • Best practices and effective health care delivery models, and
  • Business and other innovative strategies that may improve HCV treatment access.

Participants described HCV treatment access challenges and opportunities that exist at systems, organizational, governmental, and provider levels, and discussed strategies to improve national efforts to address them. Specific key issues and potential actions were discussed such as:

  • Payer (e.g., state Medicaid agencies, private insurers) restrictions on HCV treatments,
  • Cost and price of DAAs,
  • Availability of HCV surveillance and real-world treatment outcome data,
  • Health care system capacity for treating HCV, and
  • The role of expanded HCV screening (e.g., increasing screening rates, expanding screening recommendations).

Participants highlighted that in order to maximize the potential benefits of these new, curative DAAs, changes in attitude, education, awareness, policy and practice will be needed. Accurate and relevant data are required to help inform decision making and understand the strategies and policies can further support the systems changes needed to best meet the needs of patients with chronic HCV and the healthcare providers and systems that serve them.

This consultation reflects ongoing efforts by HHS to engage with diverse stakeholders, continue to build partnerships and collaboration among federal and nonfederal entities, and work to prevent new infections, reduce deaths and improve the health of people living with viral hepatitis, and reduce viral hepatitis health disparities in the United States.

Slide Presentations

HCV Treatment Access in the United States: Needs vs. Reality

Brian R. Edlin, MD, Chief Medical Officer, National Center HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention

Societal Benefits of HCV Treatment

Jagpreet Chhatwal, PhD, Senior Scientist, Institute for Technology Assessment, Assistant Professor, Harvard Medical School

Center for Medicaid Services and HCV Treatment

John Coster, PhD, RPh, Director, Division of Pharmacy, Center for Medicaid & CHIP Services, Centers for Medicare & Medicaid Services

Working to Improve Access to HCV Treatment

Kevin Costello, JD, Senior Associate Director and Litigation Director, Center for Health Law Policy Innovation, Harvard Law School Stacey Trooskin, MD, PhD, Director of Viral Hepatitis Programs, Philadelphia FIGHT Community Health Centers

HCV Cost Trends and Cost Effectiveness

Benjamin Linas, MD, MPH, Assistant Professor of Medicine and Epidemiology, Boston University, Director HIV Epidemiology and Outcomes Research Unit, Section of Infectious Diseases, Boston Medical Center

Focus on the Payer Perspective

Steve Miller, MD, MBS, Senior Vice President & Chief Medical Officer, Express Scripts

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