CDC Media Briefing — New Vital Signs Report Hepatitis C is deadly, but curable
Welcome and thank you for standing by at this time, our participants are in a listen only mode until the question and answer portion of today’s call. During that time, if you would like to ask a question, please press star one. Today’s conference is being recorded. If you have any objections, you may disconnect at this time. I would now like to turn the meeting over to Kristen Nordlund. You may begin.
Kristen Nordlund (00:21):
Thank you, Brandon. And thank you all for joining us today as we release new CDC vital signs, we’re joined by three speakers, CDC Acting Principal Deputy Director Dr. Deborah Houry, as well as the director of CDCs national center for HIV viral, hepatitis STD and prevention, Dr. Jonathan Mermin and the director of CDCs division of viral hepatitis Dr. Carolyn Wester. Our speakers will be available to respond to questions for media after their remarks. This briefing is embargoed until 1:00 PM Eastern time when our vital signs is live on the CDC website. On now, turn the call over to Dr. Houry.
Dr. Houry (01:00):
Thank you, Kristen. And good afternoon. Thank you all for joining us today. CDCs vital science series focuses on CDCs public health priorities and what can be done or is being done to address them. This latest CDC vital science report provides new information on gaps in and barriers to hepatitis C treatment in the United States. We’ll highlight some troubling findings showing low treatment rates overall, as well as disparities in treatment by type of insurance coverage, age and race. We’ll also discuss ways we can increase access to these life saving medications. Everyone with hepatitis C should have access to highly effective treatment to cure the infection regardless of age, race, or insurance status.
Dr. Houry (01:54):
Roughly 1% of the U.S. adult population has hepatitis C. It is a leading cause of death in the U.S. contributing to the deaths of about 14,000 people each year. The number of new hepatitis C infections in the U.S. has steadily increased since 2010. Another dire outcome of our nation’s opioid crisis. As a physician and a substance use disorder clinic, I witness firsthand the high burden of hepatitis C among people with substance use disorder. Given this growing burden, it is critical that we understand how to reach more people with hepatitis C treatment, including people with substance use disorder to save lives and to prevent the ongoing spread of this serious infection. To speak more about hepatitis C treatment opportunities and gaps, I will now turn it over to Dr. Mermin.
Dr. Mermin (02:52):
Thank you, Dr. Houry. I’m a physician and, and I recall the moment several years ago when the first safe effective treatment for hepatitis C was approved by the FDA. There are now several treatments to cure hepatitis C in two to three months. Almost overnight hepatitis C went from a deadly life-long chronic infection to something easily cured by medication that can be prescribed by your primary care physician. These new hepatitis C medications literally put the cure for hepatitis C in the hands of doctors and patients. And this was a medical breakthrough. However, after nearly a decade, since these safe and effective treatments became available, they are not reaching most of the people with hepatitis C. Before Dr. Wester dives into today’s findings, I wanna discuss why this matters. Hepatitis C is usually spread through blood, often from injection drug use. If left untreated, it can cause advanced liver disease, liver cancer, and death.
Dr. Mermin (03:58):
The good news is that today’s effective and safe treatments, cure people of their infection and prevent those complications. Unfortunately, availability and accessibility of treatment are not the same. As the number of new hepatitis C infections in our country continues to grow, today’s vital sign study found these treatments are not reaching everyone who needs them, even when they have continuous health insurance coverage. The initial high cost of hepatitis C medicine led to many public and private health insurance providers, creating barriers that prevented patients from being treated. This costs the nation thousands of preventable death. We need to do more to remove these barriers that people who have hepatitis C can be cured. No barrier, including paperwork or profit should keep people from life-saving treatment. Today. The cost of hepatitis C treatment is decreased dramatically because of more competition among pharmaceutical companies, payers negotiating for lower costs and innovative state treatment models. Still cost remains a barrier and many insurance providers still have restrictions in place preventing some people from accessing life-saving treatment.
Dr. Mermin (05:18):
These treatment restrictions can include requirements that people with hepatitis C must already have liver damage to start treatment, uh, or not have used drugs or alcohol for months. Uh, a specialist such as a liver or infectious disease. A physician must be involved in a person’s care, even though hepatitis C can be easily treated by primary care physicians, or the doctor must receive preauthorization approval from the insurance provider to start treatment, a paperwork barrier that prevents treatment and increases the burden on providers and patients. These restrictions prevent people from getting the treatment they need and increase health inequity. I will now hand it over to Dr. Wester to discuss the findings from this, our study in more detail and highlight some recommended action.
Dr. Wester (06:09):
Thank you, Dr. Mermin, our study used national claims and encounters data from insured individuals diagnosed with hepatitis C between January, 2019 and October, 2020 to assess how many people were receiving timely treatment, we analyzed the proportion prescribed hepatitis C direct acting antiviral medications within one year of diagnosis. We found that less than one in three people with insurance started treatment for their hepatitis C infection within a year of diagnosis. Of particular concern was the finding that not all types of insurance are equal when it comes to assessing treatment for hepatitis C. We found that hepatitis C treatment was lowest among Medicaid recipients and Medicaid recipients who were race other than white we’re up to 27% less likely to receive timely treatment than white Medicaid recipients. Such disparities could be driven by health system barriers to patient access, lack of provider availability, quality of care, patient distrust, stigma, or language and cultural factors.
Dr. Wester (07:15):
These findings are especially concerning in the context of higher rates of hepatitis C related deaths among black and Hispanic people in the United States. We found that less than one in four Medicaid recipients received hepatitis C treatment within a year of diagnosis. People with Medicaid in states where the Medicaid program restricts access to treatment were even less likely to receive treatment than people in states without these restrictions. Looking at age, we saw that treatment was lowest among adults under 40 years of age, a group that has the highest rates of new hepatitis C infections in our country. Additionally, high rates of hepatitis C in people of reproductive age, put the youngest generation at risk of infection because hepatitis C can be spread from mother to child during pregnancy and childbirth. To eliminate hepatitis C all people including younger adults must have access to unrestricted, hepatitis C testing and treatment.
Dr. Wester (08:15):
Fortunately, there are things that we can do right now to advance health equity and expand hepatitis C testing and treatment for all people. Healthcare providers, insurers, policy makers, and public health professionals should work towards, one removing eligibility restrictions and preauthorization requirements that make it difficult for people with hepatitis C to access curative treatment, two providing treatment where people with hepatitis C receive other services such as primary care offices, community clinics, syringe services, programs, substance use treatment centers and correctional facilities, three providing safe and effective treatment in as few visits as possible, and four expanding the number of primary care providers treating hepatitis C. Everyone can take an important step towards stopping the threat of hepatitis C. Testing is the first step to being cured, yet about 40% of the people, um, with hepatitis C in the United States, don’t know they have the infection. CDC recommends that everyone get tested for hepatitis C, at least once in their lifetime. To find free hepatitis C testing in their area, people can visit gettested.cdc.gov. People diagnosed with hepatitis C should talk to a provider to start treatment and get cured. And those without insurance or who cannot afford treatment can explore pharmaceutical patient assistance programs and cost sharing assistance programs. Nasda.org is one resource for more information on assistance programs for hepatitis C treatment. If we are gonna make an impact against hepatitis C, we need to connect more people to treatment and reduce disparities and access diagnosis and treatment. People shouldn’t have to jump over hurdles to access life-saving treatment. As Dr. Merman said earlier, developing a safe and effective cure for hepatitis C was a medical breakthrough, but it will not be fully realized until everyone with hepatitis C has access to treatment to cure their infection. I’ll now hand back to Dr. Houry to wrap up before we take your questions. Thank you.
Dr. Houry (10:26):
Thank you Dr. Mermin and Dr. Wester. I want to make one final and important point before we turn today’s call over for questions. The viral hepatitis national strategic plan sets forth a vision for hepatitis in our nation. One that we work toward every day here at CDC. It’s a vision that the United States has a place where new hepatitis infections are prevented. Every person knows their status, and every person with viral hepatitis has high quality healthcare and treatment and lives free from stigma and discrimination. CDC cannot accomplish this on our own. I hope policy makers, insurers, healthcare providers, and public health partners will work with us to ensure access to treatment for all people with hepatitis C, who we can realize this vision for our nation. And remember, we all have a part to play. Adults should get tested for hepatitis C at least once in their lifetime to know if they have this life-threatening, but curable infection. Thank you for joining us today. I will now turn it back over to you, Kristen.
Kristen Nordlund (11:38):
Thank you, Doctors Houry , Mermin and Wester. Brandon, we are ready to take questions.
Thank you. We will now begin the question and answer session. If you would like to ask a question at this time, please press star one. We ask that you limit yourself to one question and one follow up. To withdraw your question. You may press star two. Once again at this time, if you would like to ask a question, please press star. One, one moment, please. As we with our first question. Our first question is from Mike Stobbe. Your line is open.
Mike Stobbe (12:33):
Hi, thank you for taking my, uh, call. Um, two questions if I may. You all mentioned, uh, the number of infections each year. Could you say or say again, the current estimate of how many new hepatitis C infections are happening in the United States? And then second, Dr. Wester said, uh, something about the importance of expanding the number of primary care providers who are providing Hep C medications. Could, could you say more about that? Uh, what percentage of these, um, prescriptions are, are being started by PRI primary care? And, and is it, why is that, is it because of the insurance programs or discouraging primary care from, uh, or is, is there something else or, or some primary care docs uncomfortable, uh, uh, starting these medicines on patients could, if you could explore that a little more. Thank you.
Dr. Wester (13:29):
Thank you very much for that question. Um, this is, uh, Dr. Carolyn Wester. As far as the number of new infections each year, um, our most recent, um, surveillance report showed an estimated 60,000 new infections, approximately 60,000 new infections in the United States. And that represented a fourfold increase, um, compared to 10 years ago. And, um, new data will be released, um, within a couple of weeks, uh, to identify, um, even more recent trends. And then in terms of the, the items that are playing into, um, the primary care providers, I don’t have an access, I don’t have a specific percentage of primary care providers that are providing those services. Um, however we have seen through treatment data stratified by provider type that the percentage is increasing. Uh, there are gaps, I believe, um, not only the provider specialist requirement in some states and among some plans, but on top of it, the prior authorization process, even in the absence of restrictions, we have heard, uh, from a number of primary care providers and organizations that that paperwork burden, uh, makes it untenable in the context of a busy primary care practice that is addressing a spectrum of illnesses, uh, across a patient’s, um, care, um, in order to navigate that kind of burden as well. So number of studies have shown that primary care providers, um, including advanced practice nurses and physicians assistants can have a very high successful treatment rates. Um, we need to make sure that they are not only trained, but then equipped in an environment that really allows them to practice without hurdles.
Our next question is from Arielle Dreher. Your line is open.
Arielle Dreher (15:44):
Great. Thank you. I have two questions. Um, first, could you speak to the role that the opioid epidemic has had in the spread or increased spread of Hep C in the country? A little bit more. And then my second question is how many state Medicaid programs do not cover this treatment at all ?
Dr. Wester (16:08):
The, um, and to ask answer your first question, what is the role of the opioid epidemic in the context of, um, of, on, uh, of the hepatitis C epidemic? I think a point within our data is that treatment is missing in a group that is key to preventing transmission. Though, specifically the treatment was lowest among adults under 40 years of age, and this is exactly the same group in which we’re seeing the highest rates and the highest increases in new infections. And among this group injection drug use, um, driven by the opioid crisis is the primary risk factor reported for transmission. So ensuring that these younger adults and people who inject drugs are connected to Hep C testing and treatment is absolutely critical, not only to improving that individual’s health and preventing downstream consequences like cancer and even death, but also to prevent ongoing transmission.
Dr. Wester (17:11):
And I think it’s important also to recognize that, um, total health for substance use disorder population, particularly those who have active injection drug use need to be, um, have access to other services, including substance use disorder, treatment, and syringe service programs to protect their health, um, both now and in the future. And then the number, the second question, the number of state Medicaid programs that do not provide, um, the, this treatment. Our analysis focused on the, whether or not a state Medicaid program had at least one, um, restriction eligibility restriction for treatment access. So while these treatment access restrictions don’t necessarily take treatment completely off the table, they introduce burdens and hurdles for both providers and patients to overcome. So I, I can’t speak to whether or not there are any Medicaid programs that actually don’t even have it available, it’s just the access, um, um, it’s accessing them through the restrictions and through the prior authorization process. But I do wanna get back to the fact that we’re seeing large gaps in Hep C treatment across insurers. So we looked at private Medicare and Medicaid, and while Medicaid recipients had a 46%, uh, lower, uh, adjusted, um, odds of receiving timely treatment, it was less than one out of three individuals across all the insurance types. And these are people who are diagnosed and have continuous insurance coverage. So in many ways are the individuals who are set up to have the best access to care and treatment.
Dr. Mermin (19:09):
That, and um, what that results in is that restricting access to hepatitis C treatment, turns an infectious disease into a health injustice.
I’m currently showing no further questions. At this time. I would like to remind participants if you would like to ask a question at this time, to please press star one. One moment, please. All right, I’m showing no further questions at this time.
Dr. Houry (20:02):
Well, this is Dr. Houry, I wanna thank everybody who participated today. We appreciate you spreading this important message. I would just like to remind all that we do have a role to play and that we should all get tested for hepatitis C at least once in our lifetime to know if we have this life-threatening, but curable infection. Thank you.
Kristen Nordlund (20:22):
Thanks Dr. Houry, and thank you for all. Uh, thanks to everyone for joining us today. Please remember that today’s briefing is embargoed until 1:00 PM Eastern time. You can find information on cdc.gov/vital signs at one o’clock. Um, if you have any follow up questions, please call the main press office at 404-639-3286 or send an email to [email protected]. Thank you.
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