With the advent of the new Hepatitis C medications, treatment is no longer as complex and or side-effect burdened as it once was. As a result many people are now actively seeking treatment, yet the notion that starting treatment consists of simply being prescribed the new medications is often not the case. I often see people seek treatment without understanding there are often multiple steps and obstacles to initiating treatment. Below I will outline some of the likely steps and obstacles to expect before starting treatment.
Make Initial Visit to Health Provider - The first step is to meet with a health care provider who specializes in Hepatitis C. Your doctor will likely discuss with you your genotype, what medications can treat that genotype, and the future steps of treatment. Usually the provider will order a Fibro Scan or liver biopsy to see the condition of your liver. Blood will likely be drawn in order to assess what kind of treatment. They may also refer you to see other specialists before proceeding with treatment (depending on your specific situation).
Liver Assessment - The next step is typically getting a Fibro Scan or liver biopsy. A Fibro Scan put simply is a noninvasive procedure for doctors to see if there is damage to the liver and how much. Although less common, your health care provider may also request a liver biopsy. A liver biopsy is a minor procedure that involves inserting a small needle into the liver to collect a tissue sample. This tissue sample is then used to assess the liver condition and diagnose a variety of liver diseases.
Meet With Necessary Specialists - Often the Hepatitis C provider will request that you get the thumbs up from other specialists depending on your current medical situation. For example, if you have HIV, your doctor may require you meet with your HIV care provider and change your medication regimen before starting treatment.
Insurance Coverage for Medication - One of the most considerable obstacles of initiating Hepatitis C treatment is determining if your insurance will cover the medication and/or how you will pay for it. Unfortunately, the new medications are extremely expensive (each pill costs around $1000 in some cases).
Varying on your insurance, people without major liver damage sometimes are denied medication coverage. This is where many people get discouraged, accept negative outcomes, and sometimes give up. Being denied medication coverage is not always the end of the line. If you are denied coverage, you should ask your doctor if they can appeal the denial. Additionally, the drug companies offer patient assistance programs to pay for the medication. Below are several of the current patient assistance programs are listed:
Harvoni and Sovaldi - My Support Path
Viekira Pak - Proceed Program
Ribavirin - Moderiba
Olysio - Janseen Prescription Assistance
Pegintron and Victrelis - Merck Helps
Pegasys and Copegus - Access Solutions
Start Medications - Once your medication is approved you may receive your medication at either a specialty pharmacy or it may be mailed to your house or doctor's office. Depending on your genotype, viral load, and other medical factors the duration of treatment usually ranges from 12 to 48 weeks.
Provider Follow Up - While on these medications expect to have multiple follow up appointments. Your health provider will monitor your viral load among other medical factors. Additionally, you may need to come and pick up your medications from your providers office. Often insurance companies will approve a one month's supply of medications initially. Therefore these health care provider appointments are essential in order to complete treatment.
Achieve SVR - After discontinuing medications, successful treatment is defined as achieving sustained virologic response (SVR). SVR is achieved when a person has an undetectable viral load for six months. This is in essence when patients are considered 'cured.'