The Federal Government has announced that it will list new hepatitis C drugs on the Pharmaceutical Benefits Scheme (PBS). The move means that 230,000 hep C sufferers will get access to the new treatment which has a success rate of over 90% with few side effects. Access in Australia will be obtained for the standard PBS co-payment of $37.70 per month or $6.10 for concessional patients. Without the subsidy the medication would cost up to $100,00 for the twelve week course of treatment.
One only has to look to the USA to see the value of our PBS system and how out of pocket expenses affect lower income earners. The appalling statistics on HIV control in the USA are a good illustration of this point
Charlie Sheen’s recent revelation that he is HIV positive led to publication of figures that demonstrate the inadequate treatment of many people who are infected with HIV in the USA.
With appropriate antiretroviral (ARV) treatment, 90% or more HIV infected people should be able to achieve “undetectable viral load”. This means that, although they are still HIV positive, the level of the virus within the body is so diminished that it cannot be measured through testing. Those infected must still take medication on a daily basis. But otherwise they can lead a relatively normal life.
Charlie Sheen has undetectable viral load. He stated that it was therefore “impossible” that he transmitted the virus to others. There is no such thing as “impossible” in science. But for practical purposes research does suggest that a person with undetectable viral load may not be able to pass on the virus. Researchers calculate that the average real-world risk reduction as a result of an undetectable viral load would be 95%. But Jens Lundgren, MD, chief physician and director of the Copenhagen HIV Programme, estimated that it is likely that the chance of a person with an undetectable viral load transmitting HIV is closer to zero, or perhaps even is zero.
Effective ARV treatment to achieve undetectable viral load is therefore not only desirable for the infected individual. It is also a vitally important as a public health measure for containing the further spread of the virus. Where high rates of undetectable viral load are achieved amongst an HIV infected population, it appears that new infections are largely spread by those who are unaware that they have contracted the infection.
An estimated 1.3 million people in the USA are HIV positive. An estimated 82% of these cases have been diagnosed as having the virus. But only an estimated 25% of those infected have undetectable viral load. This compares to a figure exceeding 90% in Australia where ARV medication can be accessed through the PBS.
Failure to effectively treat HIV infection leads to AIDS. More than 13,000 Americans a year die from AIDS. Many of these deaths would likely be preventable through proper ARV treatment. Deaths from AIDS in the USA is yet another illustration that being poor and uninsured for health cover in the USA is a potential death sentence.
The reasons for the low rate of effective ARV treatment in the USA include substance addictions and mental illness. These conditions can interfere with sufficient compliance in the daily requirement to take ARV medication. But insufficient treatment is also the result of poverty, of not being covered by health insurance and by the lack of affordability of ARV medications in the USA for those on lower incomes.
ObamaCare (The Affordable Care Act) did improve the situation for HIV positive people in the USA. But the continued role of private insurers within the system is undermining affordability of HIV medications.
Before ObamaCare insurance companies could simply refuse to cover people with HIV or other costly conditions. ObamaCare attempted to end these practices by requiring insurers to sell policies to all comers, regardless of pre-existing conditions. But now advocates for HIV patients, and others with chronic diseases including hepatitis C, say some private health insurance plans are making them bear a huge cost for life-saving medications.
Many insurers have placed HIV drugs in the most expensive co-pay or coinsurance tiers, the latter of which requires paying a percentage of the drug’s cost as opposed to a flat fee. According to the Fair Pricing Coalition, the result is that many people with HIV will hit their maximum out-of-pocket cap within the first few months of their insurance plan’s policy year.
Dr. Jose Lares-Guia, a Manhattan solo practitioner, who has a large HIV practice, says some of his patients are maxing out their credit cards or going without medication. Others are traveling to Canada, Mexico, or the U.K. seeking cheaper drugs. Insurance companies are “making the plans for people with HIV absolutely unattractive so they don’t choose them,” he says.
The United States has the highest costs for drugs in the world. ObamaCare does not appear to have achieved sufficient reductions in these costs to ensure adequate access to prescription medications. Soaring pharmaceutical costs are not limited to HIV medications; many people with cancer, hepatitis C, and other complex and expensive illnesses have been facing similar increases.
By way of contrast, in Australia, people infected with HIV are able to access free public health ARV treatment with access to affordable ARV medication.
In Australia an estimated 23,800 people are HIV positive. About 88% of those are aware of their HIV-positive status. This is an awareness level that is only 6% higher than in the USA. But at the end of 2014, an estimated 73% of HIV positive Australians were receiving ARV treatment and 92% of these were estimated to have achieved undetectable viral load.
This is just one more example of the importance of protecting the integrity of our public health system, our pharmaceutical benefits scheme, affordable access to diagnostic assessment and for resisting all attempts to Americanize our health system.