Can the Netflix model eliminate the most infectious disease in America?

Two states fighting a worsening of the hepatitis C crisis will soon pay a flat fee for unlimited drugs – Netflix-like – to cure prisoners and low-income residents suffering from deadly liver disease , the goal being to remove the infection.

Netflix charges customers a monthly fee to view all the movies they want. Louisiana and the state of Washington want to do the same with expensive drugs that cure hepatitis C, a blood-borne disease transmitted by drug injection, blood transfusion and other unsafe health care practices.

Both states will pay a drug manufacturer to provide enough drugs each year to treat its prisoners and Medicaid patients. Washington is also considering buying drugs on behalf of third parties, including state employees, retirees and teachers.

The new design illustrates how states are trying to be creative in tackling one of the most costly but important challenges in the long-term: providing low-income residents and people in care with care. access to health care.

Hepatitis C kills more Americans every year than any other infectious disease, more than the total of 60 infectious diseases reported to the US Centers for Disease Control and Prevention. And ultimately, Louisiana and Washington hope that commercial health insurance companies will adopt a similar model to cover the virus of all state residents.

In Washington, Democratic Governor Jay Inslee announced last fall a mission to eradicate hepatitis C by 2030.

Alexander Billioux, deputy secretary of public health for the Louisiana Department of Health, said his country's plan "is not about getting a good deal for a drug."

"The most important strategy is to eliminate the deadliest disease in Louisiana," Billioux said.

Australia set up the Netflix model in 2015, agreeing to spend about $ 1 billion to treat approximately 104,000 people with the disease over five years. A recent analysis published by the New England Journal of Medicine Australia would save nearly $ 6.5 billion more than if it had tried to treat the same number of people using the traditional pricing method.

Although officials in Washington and Louisiana are not able to negotiate better prices with the Netflix model, health officials said it would provide more certainty about state spending on treating hepatitis C in the US. year after year.

"We think it will protect us from excessive spending every year [on hepatitis C drugs]Said Judy Zerzan, chief medical officer of the Washington Health Care Authority.

When states unveiled for the first time their draft model subscription, some officials wondered if any of the manufacturers of hepatitis C drugs – Gilead, AbbVie and Merck – would be interested to participate. As bids have not yet expired, this remains unclear, but manufacturers have asked the two states detailed questions about their projects, which is typical of contracts with states. Offers are due for Louisiana this week and the following week for Washington.

None of the companies responded to StatelineInquiries about the models of Louisiana and Washington.

Both states also expect the successful bidder to contribute to public health efforts to identify and screen those at high risk of contracting the disease and to train health care providers.

Although the underwriting model may not be useful for all prescription drugs, "in case of infectious disease in the population, this could make a lot of sense," said Anna Kaltenboeck, director of the Drug Pricing program. Lab, who studies drug prices at Memorial Sloan Kettering Cancer Center in New York.

Other states have also set ambitious goals of ridding their state of hepatitis C. The Democratic government of New York's Andrew Cuomo has pledged last year to scrap the government. Hepatitis C in this state without specifying which date. The state estimates that more than 100,000 people in New York are infected.

Both Billioux and Zerzan stated that other states had asked about their subscription models, although neither of them had identified the states.

But the success of anti-hepatitis C drugs could lead states to expand their programs to other drugs.

Billioux said the likely candidates would be the drug, naloxone, used to treat opioid overdose, and pre-exposure prophylaxis, a combination of two drugs used to prevent HIV in high-risk populations.

According to the CDC, about 2.4 million US residents were living with hepatitis C in 2016, the most recent data available. Many are unaware that they have the disease, and if left untreated, it can cause liver damage, cirrhosis (or scarring of the liver), cancer, and death. Many patients are infected with blood transfusions, although the infection rate is particularly high among those who share needles when they consume drugs, such as heroin, illegally.

Until 2014, drugs used to treat hepatitis C were not particularly effective, required long treatment times and resulted in serious side effects. But that year, the US Food and Drug Administration approved a new generation of antiviral drugs for hepatitis C that promised a cure, with virtually no side effects and only needed for eight weeks .

The drugs cost an incredible price, ranging up to $ 94,000 for a single treatment. Alarmed by the fiscal impact, states initially tried to limit new drugs to Medicaid beneficiaries and prisoners only at an advanced stage of the disease, by refusing them to others.

However, several federal courts have ruled that it is illegal to refuse treatment that can save lives for those infected.

States have taken a break: other drug companies have submitted their own versions, lowering prices. For the Medicaid program in Washington, the price of treatment has dropped from $ 43,599 in 2015 to $ 22,433 last year.

However, because of the prevalence of hepatitis C, the overall costs of Washington State remain high. Last year, the company spent more than $ 80 million in anti-hepatitis C drugs for the treatment of patients, including those in Medicaid and prisons, as well as employees of the Ministry of Health. State.

But Zerzan said that even with these expenses, only a fraction of the estimated 30,000 infected people in the Health Care Authority's jurisdiction had been treated.

"We are reaching about 3,000 people a year at Medicaid, but we need to do better than that to eliminate hepatitis C," said Zerzan. The state estimates that another 35,000 people outside the other's jurisdiction also have the disease.

In the Washington model, the successful bidder would provide the drugs up to 2023 at a fixed price for treatment up to an annual maximum, about $ 80 million spent by the state. last year. (The total will be determined by negotiation with the manufacturer, subject to the approval of the legislator.) Once this maximum reached, the manufacturer will provide the drugs for a negligible amount, perhaps as little as a few cents per treatment.

The model would work the same way for hepatitis C drugs intended for non-Medicaid patients under the authority of state health care, which manages the state's Medicaid program and buys health plans for employees of the state.

Louisiana would cap for five years the amount it would spend on antivirals to the amount spent in 2018, about $ 35 million. For this amount, the winner (or candidates) would agree to provide all necessary medications for the treatment of all beneficiaries and Medicaid prisoners identified by the state.

Louisiana estimates that about 39,000 people with hepatitis C are Medicaid recipients or are incarcerated. He estimates at around 90,900 the total number of people in the virus.

The state hopes to treat 10,000 Medicaid beneficiaries and prisoners by the end of 2020. Last year, it treated only 1,170 people.

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