One year after being accused of rationing treatment, the Department of Veterans Affairs will spend $1 billion on drugs for Hepatitis C Veterans in fiscal year 2016, and anyone with the virus will receive access to treatment regardless of the stage of the disease.
The drug “sofosbuvir” is a prescription medication for the treatment of Hepatitis C. Sold as Sovaldi, it boasts a 93% cure rate, according their website, citing a clinical study in which 68 of 73 patients were cured. The cure, however, comes at great cost. A cost, it seems, that the VA couldn’t afford.
The retail price for a 12-week treatment for the drug sofosbuvir was $84,000, according an investigative report published in December 2015. Even with a 50 percent discount, The VA still couldn’t afford to treat everyone who needed it.
In late 2015, the VA created a “dashboard” for Hepatitis C – Advanced Liver Disease, using criteria including age, gender, geography, service era, race and ethnicity to identify Veterans at highest risk for advanced liver disease. Hepatitis C treatment was offered to only the most ill due to lack of funding. Even so, the VA allocated $696 million for the new Hepatitis C drugs, which represented about 17 percent of the VA’s total pharmacy budget.
On March 9, 2016, the VA announced it now has funding and can provide care to all Veterans with Hepatitis C for FY2016, regardless of the stage of the patient’s disease. The VA expects to spend approximately $1 billion on Hepatitis C drugs in FY2016 — thanks to increased funding from Congress and reduced drug prices.
About Hepatitis C
Hepatitis C is a virus that causes inflammation of the liver. The Hepatitis C virus replicates in the liver, causing an immune system response. The immune system response process can cause scarring and loss of function over a long period of time. There is no vaccine for the virus.
Veterans appear to contract the Hepatitis C virus at a much higher rate than their civilian counterparts, with some reports of Veterans being infected at a rate of 5 times greater than the general population.
Out of 100 people who have Hepatitis C, 75 to 85 will develop a chronic infection, and two of those will develop liver cancer. If left untreated, another 17-20 may develop cirrhosis within 20 years of being infected.
- Hepatitis C can be transmitted, so caution is needed to avoid infecting others
- Hepatitis C is a leading cause of liver cancer
- Hepatitis C is the most common reason for liver transplants
- Hepatitis C causes about 15,000 deaths in the United States each year
- Vague discomfort in the abdomen, stomach pain
- Joint pain or muscle soreness
- Itchy skin
- Nausea, loss of appetite
You should get tested for Hepatitis C if you:
- Are a Vietnam-era Veteran
- Were born between 1945 and 1965
- Had a blood transfusion or organ transplant before 1992
- Received a blood product for clotting problems made before 1987
- Have liver disease or abnormal liver function test
- Were born of a mother who had hepatitis C at the time
- Were on long-term kidney dialysis
- Had exposure to mucous membranes or to non-intact skin, or a had a needle stick injury
- Had contact with Hepatitis-C-positive blood to non-intact skin or to mucous membranes
- Ever shared a needle to inject drugs, or a straw to inhale them
- Got tattoos or body piercings using non-sterile equipment
- Have a history of alcohol abuse
- Have ever had a sexual partner with Hepatitis C
- Have had 10 or more lifetime sexual partners
- Have HIV infection
- Shared toothbrush, razor or other personal care items with a person infected with the virus
Veterans without any of the risk factors above should also consider getting tested if they were immunized with an “airgun” while in service. Jet injectors using the same nozzle tip were used in the military for decades when many service members needed to be vaccinated with the same vaccine in a short period of time. While many sources held the line of military injectors were “never implicated in transmission of blood borne infections”, the military discontinued their use in the late 1990’s.
According to the VA Frequently Asked Questions about viral hepatitis, “Getting service-connection for HCV infection is difficult. Most people cannot prove that they got HCV during their military service.”
A search of The Board of Veterans’ Appeals Decisions resulted in more than 6,500 cases in 2014 and 2015 that included “Hepatitis C” and “Vietnam” in the appeal. A review of all cases was not attempted. Of the first 5 cases reviewed, two cases were found to have been decided in the Veteran’s favor. Though these cases are not precedent setting, they may be helpful as background information for Veterans researching the subject.
- Citation Number 1553509: Concluded that the Veteran most likely contracted Hepatitis C from receiving immunizations by an airgun.
- Citation Number 1459982: Concluded Hepatitis C and pruritus as secondary to Hepatitis C was connected to military service.
One case for service connection of Hepatitis C was denied because the Veteran’s records did not show a current diagnosis of Hepatitis C. We assume there is more to that story.
References and Resources
Liver Foundation at http://www.liverfoundation.org/
Hepatitis C Brochure – http://www.liverfoundation.org/downloads/alf_download_24.pdfU.S. National Library of Medicine – http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022399/Centers for Disease Control and Prevention – http://www.cdc.gov/hepatitis/index.htmU.S. Department of Veterans Affairs – http://www.hepatitis.va.gov/index.aspVA testimony to the Subcommittee on Benefits | Committee on Veterans’ Affairs | U.S. House of Representatives – http://www.va.gov/OCA/testimony/hvac/13ap00GR.asp