The Biden administration is seeking billions of dollars for another effort to eradicate hepatitis C, a virus that kills thousands of people in the US every year, despite the existence of highly effective drugs that can cure the infection within months.

The five-year program, outlined Thursday by White House officials as part of a broader budget proposal, is estimated to have a net cost of $5 billion over a decade, said Dr. Francis Collins, a special adviser to the president on special projects.

It would require an upfront investment now estimated at more than $11 billion over five years, which Collins said would be offset by government savings to prevent liver failure and other conditions that result from hepatitis C and thus reduce the cost of avoid its treatment.

The exact cost would depend on negotiations with drugmakers, who would receive a flat fee to make an unlimited supply of immediate-acting antiviral pills available to patients on Medicaid, as well as those who are uninsured, incarcerated, or receiving treatment through the Indian government. Health Service, said Collins, the former director of the National Institutes of Health.

Such “subscription” deals have already been piloted in some states in an effort to expand access to the life-saving medication.

White House officials said the drugs can now cost about $20,000 per patient, but researchers have found that curing patients could ultimately save money that would later be spent on treating liver disease. A recent study by the Veterans Affairs system concluded that treating each hepatitis C patient would save more than $62,000 over time, resulting in billions of dollars in savings for the system.

The Biden administration argued that its plan would reduce Medicaid spending by “hundreds of millions of dollars” a year

2023 2032

.

Collins and senior White House adviser Rachel Fleurence outlined more details of the proposed program Thursday in the Journal of the American Medical Assn.

Under the five-year plan, the Biden administration also wants to accelerate approval for “point-of-care” tests that would allow people to get tested and begin treatment immediately during the same visit; train more medical providers to provide the medication; and reviving efforts to develop, among other things, a vaccine that could threaten re-infection with the virus.

The proposed program also includes assistance with copays for Medicare recipients struggling to afford the pills, expanding patient screening, and supporting community clinics and other access sites to match people to treatment.

The budget proposal released by the White House on Thursday forms the basis for negotiations with Congress on the spending priorities put forward by President Biden. Collins said he hopes that “when members of Congress see what a unique opportunity this is to save lives” and to save money in the long run “it will be hard to just look away.”

“If we are a country that cares about all its people,” he said, “how can we say no?”

Dr John W. Ward, director of the Coalition for Global Hepatitis Elimination at the Task Force for Global Health, praised the proposal and said it would be the largest commitment to eradicating hepatitis C ever put forth by the federal government . Eradicating hepatitis C “is an incredibly achievable goal for the nation to achieve,” he said.

“We have safe and effective therapies. We’ve shown we can do it for thousands of military veterans. Now it’s time to do it for the whole country.”

His coalition has helped university researchers model the lives and money that could be saved by a national program, he said, and “it’s a real win-win.” Because the subscription model means “you have one price to treat an unlimited number of patients,” it encourages medical providers to find and treat more infected people, Ward said.

Hepatitis C spreads through infected blood, including through shared needles or other drug-injecting equipment. It has taken a disproportionate toll on marginalized groups, including people who inject drugs, have been removed from their homes or are in prison.

Millions of people across the country are believed to be infected, but many are unaware they have the virus. It’s a slow-moving killer that can take years to cause symptoms, but if left untreated, hepatitis C can cause cirrhosis, cancer, and eventually death.

The infection can now be stopped in most cases by taking direct acting antiviral medication for two to three months. Still, patients in the U.S. don’t get treated quickly: Only about a third of patients with private insurance and a quarter of those on Medicaid started taking the pills within about a year of diagnosis, researchers from the Centers for Disease Control and Prevention.

Health researchers and advocates have criticized barriers to obtaining the expensive pills raised by insurers, logistical obstacles in the step-by-step process for many patients to access treatment, and persistent misconceptions among physicians about the medication, among other things. While the high cost of the medication was a clear barrier, the rollout of programs in Washington state and Louisiana that provided prepayment for an unlimited supply of pills has underlined that cost is not the only obstacle to getting people to treatment. In Washington state, the number of treatments in the Medicaid program fell even after the initiative began as other aspects of the elimination plan were sidelined amid budgetary concerns and the pandemic, a

STAT study

found last year. Collins said the national effort was designed with lessons learned in Washington, Louisiana and other states in mind. For example, “they lost a lot of people between visits one, two and three” to get the treatment, said Collins, who shows why it is important to be able to test and treat people in the same visit. The “point-of-care” tests that could make that possible are already available outside the US and appear to be

Increase the chance

of patients being treated. When existing programs to eradicate hepatitis C struggle, it’s often because “our health care system isn’t meeting people where they are,” says Rena Conti, an associate professor at Boston University’s Questrom School of Business who consulted Louisiana as an economist. about her program. Point-of-care testing in the hands of local providers ready to use it in conjunction with the curative drugs is what “really presents this program as the answer here.”