Louisiana Is Getting an Unlimited Supply of a $24K Hep C Cure (HBO)

Louisiana has struck a deal to improve access to a Hepatitis C cure so expensive that some people only acquire the drug once they already have liver damage.

Gilead Sciences, the owner of Hepatitis C cure Epclusa, will now provide an unlimited supply of the generic version of the drug to people covered by Medicaid and in Louisiana’s state prisons. Asegua, a subsidiary of Gilead making the generic, will supply the drugs.

The list price of Epclusa is $74,760; the generic is priced at $24,000. Medicaid receives a discount price, but in many states, including Louisiana, Medicaid only approves the treatment after Hepatitis C causes severe liver damage because of its astronomical cost.

Under the deal, dubbed the “Netflix model,” Louisiana will pay for the Hep C cure up to a negotiated spending cap in exchange for an unlimited supply of the drug over five years. The state will then receive a rebate from Gilead for all its expenses above that cap.

The Louisiana Department of Health first chose Gilead as a partner for the deal back in March, after three drug companies submitted proposals to the state. Since then, negotiations stalled, to the point that the agreement nearly fell through entirely. But this week, the deal closed, Louisiana Secretary of Health Rebekah Gee confirmed to VICE News.

Gee said she hoped to not spend more than $30 million — the cost of treating only 326 people last year, according to the state’s Department of Health. The pricing cap won’t be announced until next week, but Gee told VICE News that Gilead agreed to a higher amount than that. Louisiana will hold an official signing on the deal next week, according to Gee.

“We need to get our money’s worth,” Gee said. “Our goal is 10,000 [treated people] next year, but we’ll have to hit a lot less than that to make it work.”

Gee estimated that around 40,000 people in Louisiana suffer from Hepatitis C, a chronic liver disease spread through blood. It’s the most widespread infectious disease in the U.S. The CDC estimates 2.4 million people in the U.S. were living with Hep C in 2016, the latest year with data available.

Louisiana hopes to use the deal to attempt to eliminate the disease entirely.

As Hep C most commonly spreads through shared needles, the opioid epidemic has only made its prevalence worse. The CDC estimates that 41,200 people were infected in 2016.

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California Is Trying To Fight A Deadly Hepatitis A Outbreak (HBO)

Last week, California Gov. Jerry Brown declared a state of emergency amid a growing outbreak of Hepatitis A, a highly-contagious virus that affects the liver. In San Diego, where more than 500 cases have been reported, the virus has already killed 19 people dead.

“I’ve been a nurse here for 25 years,” said Paulina Bobenrieth, who works for San Diego County’s public health department. “And this is an unprecedented outbreak.”

The outbreak has been unprecedented not because of the virus itself, but because of the people it’s affected: illicit drug users and the homeless. Hep A spreads by fecal matter—even in microscopic amounts—so those who lack access to proper sanitation are the most at risk.

That’s why Bobenrieth and other county nurses have been traveling around San Diego, along with police officers and local outreach groups, trying to reach the homeless where they are. “In other outbreaks, we had people that came to us seeking the vaccine. In this case, we needed to really find them and make it easy for them,” she said.

But for all their efforts, the number of cases of Hep A continues to rise. Even as city and county officials scramble to stop the spread of the virus — bleaching the streets, installing bathrooms and portable handwashing stations — the outbreak is also forcing them to confront the larger issue of homelessness, which may have led to the outbreak in the first place.

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