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Louisiana Enters into Subscription Model Contract for HCV Treatment

by David M. Reutter

n June 2019, Louisiana officials entered into a contract that will allow prisoners and Medicaid patients to receive advanced medications to treat hepatitis C (HCV). The five-year contract with Asegua Therapies, a subsidiary of Gilead Sciences, aims to treat at least 31,000 of the state’s 39,000 HCV-positive residents by 2024 – a ten-fold increase over current treatment levels.

“This partnership will have a direct and immediate impact on the most vulnerable populations with hepatitis C – people who are on Medicaid or who receive care through the state corrections system. These populations are disproportionately affected by hepatitis C and often face the greatest difficulty in accessing care,” said Gregg Alton, Chief Patient Officer at Gilead Sciences.

Because HCV infections are easily spread by sexual contact and sharing needles, the disease poses a health risk to the rest of the population. About 3.4 million Americans carry the virus, which can cause liver inflammation and immune-response liver damage, though 70 to 80 percent of carriers have no symptoms.

In 2018, Louisiana treated only 384 patients with Asegua Therapies’ HCV drug Epclusa, one of a new class of medications called Direct Acting Antivirals (DAAs). The drug increases the effectiveness of HCV treatment from 50 percent to 95 percent, but at a price per patient of $10,000 – still significantly less than when it was first introduced in 2014.

Lawsuits filed in 2018 and early 2019 by Louisiana state prisoners Richard Henderson, Tony Cormier and Level Doughty alleged the failure to treat them with DAAs was an “egregious act” that put them at risk of liver failure. The three men are housed in a medical unit at the Elayn Hunt Correctional Center.

The trio of lawsuits claimed the refusal of prison officials to administer the latest DAA drugs was due to their cost, amounting to a policy of “let them die” that reportedly contributed to the deaths of 15 state prisoners between 2014 and 2016.

“The guys that didn’t file suit died waiting for the state to do the right thing,” said plaintiff’s attorney Joseph Long.

“We’ve never refused medical treatment or care because of cost,” insisted Jimmy LeBlanc, secretary of the Louisiana Department of Corrections (DOC).

In fact no one actually dies from HCV, noted DOC spokesman Ken Pastorick, but complications attributed to the disease claim the lives of more Americans each year than all other infectious diseases combined.

Baton Rouge Nurse Practitioner Elizabeth Britton said her unincarcerated Medicaid patients began receiving DAAs in 2014, but prisoners at the Elayn Hunt facility did not start getting the new drugs until 2017. Even then, another 10 Louisiana prisoners died due to complications from HCV in 2017 and 2018.

Because the state was paying for DAA treatments on a per-patient basis – at a total cost of nearly $60 million annually – the price to treat all state residents with HCV, including prisoners, was estimated at $760 million. The state’s new contract with Asegua Therapies is based on a “subscription model” that allows Louisiana to pay a flat annual fee of $58 million – equal to its current spending on DAAs – for unlimited HCV treatment. Over the five-year agreement, the state’s costs will be capped at $290 million.

“We knew we had to do better,” said Governor John Bel Edwards when signing the contract with Asegua Therapies.

“We are committed to supporting efforts to eliminate hepatitis C in communities around the world and are excited to partner with the visionary leaders in Louisiana to make this public health opportunity a reality in this state,” added Alton.

HCV treatment for Louisiana residents under the state’s new subscription arrangement began on July 15, 2019. 

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Sources: Associated Press, The Advocate, modelhealthcare.com, ldh.la.gov, mavyret.com, gilead.com