More HIV providers are treating hepatitis C than ever before—provided the private insurers and public payers permit it.
That’s one reason the American Academy of HIV Medicine (AAHIVM) has created an Institute for Hepatitis C, an interactive on-line space to, as their Board of Directors say, “advance knowledge of HIV/HCV co-infection care through educational initiatives, prevention and testing information, relevant research and policy activities.”
I spoke with Dr. Margaret Hoffman-Terry, Vice Chair of the AAHIVM Board of Directors, about why the organization believes the institute is needed now. She explained that a recent survey conducted by the academy showed that approximately one in four patients being seen by HIV treatment providers in community clinics, private practices, and other settings is infected with hepatitis C. She also pointed out that eighty-one percent of the clinicians responding to the survey said they believed they had the proper knowledge to treat hepatitis C, but the vast majority of those (ninety-two percent) also said they would like even more professional support on this subject.
Hoffman-Terry also explained that research in the hepatitis C virus (HCV) has benefited greatly from the framework of HIV research, and consequently is progressing rapidly, making huge strides in a few years that previously would have taken decades.
“We saw the treatment world for hepatitis C mirroring treatment for HIV, especially with the new antiretroviral drugs that have come out in the last year,” she tells A&U.
In her own practice, about one-third of her patients are co-infected, a ratio that many other doctors are seeing (AAHIVM’s statistics show that one-quarter of the 1.2 million HIV-infected Americans already in care for HIV are co-infected with HCV).
“The institute is a way to give providers with co-infected patients more up-to-date information in this rapidly changing field. They [the providers] already understand virology, resistance, drug–to-drug interactions, and the psychosocial needs of this population, but they would also like additional support as well.”
Much of that support will be through the practice-focused e-newsletter, which will come out every two months and will share both clinical and non-clinical information to guide the treatment of hepatitis C. The first newsletter has already been posted on-line and can be accessed at http://www.aahivm.org/hcv.
In addition, the Institute plans to expand some of AAHIVM’s HCV policy and educational initiatives, such as the clinical workshops on co-infection.
“The great news is, the new medications [for treating HCV] are much simpler to work with than interferon, and the success rate is very high,” she says. “But there are issues that doctors and their patients need to be aware of as well. Can patients adhere to the regimen? What about interactions with HIV meds? Those are just a few.”
Navigating the payment maze
In addition to wanting to stay current on treatment guidelines, a majority of AAHIVM’s survey respondents said they need help in jumping the many payment hurdles for their patients. Sixty percent of survey respondents expected or have experienced insurance or cost access barriers to prescribing hepatitis C treatments to their patients, Hoffman-Terry says.
And the Affordable Care Act, which has made private insurance available for many more low-income people nationwide, has not made paying for meds simpler, or cheaper, in every case. Even 80/20 copays for meds can be an unrealistic burden for some patients who want a more expensive regimen. Many times doctors can find better payment options for new HCV meds by purchasing them directly from the pharmaceutical companies, but most doctors don’t know this.
“The paperwork is a big burden for all doctors, and the payers know this,” said Dr. Hoffman-Terry. As Clinical Associate Professor of Medicine, Morsani College of medicine of USF, Lehigh Valley Health Network, Hoffman-Terry admits that she relies on several assistants to look for the best and cheapest way to get her patients covered with the newest meds. “But not all doctors treating hepatitis C patients have that kind of assistance,” she adds.
And Dr. Hoffman-Terry says she’s disappointed that so many payers have restrictions against allowing HIV experts to treat HCV in their co-infected patients. “It doesn’t make a lot of sense, because HIV and HCV are similar diseases in many ways, and having one doctor who understands both can make it much simpler for the patient and make it easier to promote adherence and manage any side effects.”
Dr. Hoffman-Terry admits that many of the criticisms she and other HCV doctors with payers may be worked out in the coming months. In the meantime, she believes the Institute will be an important clearinghouse of information and a go-to resource for understanding the breakneck-speed of developments in the treatment of hepatitis C.
Larry Buhl is a radio news reporter, screenwriter, and novelist living in Los Angeles. His podcast on employment issues, “Labor Pains,” can be found at www.laborpainspodcast.com.