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6 Financing Elimination
Pages 147-176

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From page 147...
... Eliminating the public health problem of hepatitis B and C is still a bold goal, and reaching it will require more money for prevention and treatment. This chapter discusses strategies to increase funding for viral hepatitis elimination and ways to reduce the cost of treatment.
From page 148...
... The World Health Organization (WHO) reckons that viral hepatitis elimination could cost up to $11 billion a year by 2025 (Alcorn, 2015)
From page 149...
... recently reminded Ryan White program managers of their responsibility to screen HIV patients for HCV, and of guidelines for treating viral hepatitis with HIV coinfection (HRSA, 2015)
From page 150...
... . Since 2003, states have also been able to assist Ryan White beneficiaries with health insurance costs, such as premiums, coinsurance, co-pays, and deductibles, as long as the private insurer provides prescription drug coverage equivalent to what the state's AIDS Drug Assistance Program would offer (HRSA, 2007, n.d.-d)
From page 151...
... By the same token, hepatitis B patients, who have a chronic viral infection, might be suitable candidates for assistance with health insurance. Any modifications to the Ryan White Act should make it clear that any services for viral hepatitis patients would be in addition to the program's goal of supporting treatment for poor and uninsured HIV patients.
From page 152...
... . Bulk purchasing for volume discounts can help state Medicaid programs and other buyers manage the drug cost, though a licensing strategy loosely inspired by the Vaccines for Children program may be more effective.
From page 153...
... . The National Vaccine Advisory Committee determined that failure to immunize children aged 12 to 15 months had caused the epidemic, and recommended a federal grant program fund the purchase and delivery of vaccines for children who were not insured for them (National Vaccine Advisory Committee, 1991; Orenstein, 2006)
From page 154...
... . State Medicaid programs and health departments save money because of Vaccines for Children, as do participating private clinics.
From page 155...
... As the direct-acting agents are still on patent, licensing rights to a patent would be an excellent way to increase access to treatment without significantly increasing costs for public payers. Recommendation 6-1:  The federal government, on behalf of the De partment of Health and Human Services, should purchase the rights to a direct-acting antiviral for use in neglected market segments, such as Medicaid, the Indian Health Service, and prisons.
From page 156...
... Once the government acquires adequate rights, it would contract with manufacturers to produce the drugs and with distributors. Projected Cost of the Buyout About 700,000 people in state Medicaid programs and prisons are eligible for treatment with direct-acting agents.7 The exact prices state Med 7  Combining the roughly 100,000 eligible prisoners (Beckman et al., 2016)
From page 157...
... The actual transaction amount will depend on the degree to which firms compete with each other 100,000 potential patients in the Indian Health Service dependent on state Medicaid programs as there are no HCV drugs on the service's formulary (CMS, n.d.; Edlin et al., 2015; Indian Health Service, 2016; Leston and Finkbonner, 2016)
From page 158...
... These costs will be split roughly evenly between the federal and state governments, as the federal government provides matching funds to state Medicaid programs. Under the scenario where the federal government follows this recommendation and buys rights to a patent for about $2 billion, the cost to the federal government is the $2 billion for the rights and $70 million for generic drug purchases.
From page 159...
... Selling prescription drugs is a federal crime,12 and as long as treatment expansion proceeds as recommended in Chapter 4, the benefit is minimal. If such diversion became more than an anecdotal problem, some variant of directly observed treatment would be necessary.
From page 160...
... Furthermore, the government has the authority to exercise its rights to patent use under section 1498 at any time. The last time the government even hinted at taking such action against drug company was in 2001, when, during the anthrax scare, the manufacturer of ciprofloxacin initially refused to lower its prices to support national stockpiling (Brennan and Shrank, 2014; Kapczynski and Kesselheim, 2016)
From page 161...
... . Gilead offered Medicaid programs a 10 percent rebate only on the condition that they drop access restrictions, thereby increasing states' total spending on the drug (Senate Committee on Finance, 2015)
From page 162...
... CMS is explicitly disallowed from negotiating bulk discounts for the program (Kevles, 2014) .13 The state Medicaid programs have other ways to control drug costs.
From page 163...
... Unlike the drug rebates available to Medicaid programs, 340B discounts are generally provided up front to eligible providers, 26,907 organizations in 2014 (Fein, 2016) .14 Participating hospitals and clinics 14  In some states the AIDS Drug Assistance Program may choose to receive rebates rather than front-end discounts.
From page 164...
... SOURCE: National Conference of State Legislatures, 2015.
From page 165...
... : Formed in 2005, seven state Medicaid programs participate (CT, ID, LA, MD, NE, PA, and WI) and receive supplemental rebates on a variety of medications (National Conference of State Legislatures, 2015; Provider Synergies LLC, n.d.-b)
From page 166...
... . Therefore, clinics serving vulnerable populations need to decide before enrolling in the program if their Medicaid patients' drugs will be purchased through 340B or through the state Medicaid program (HRSA, n.d.-b)
From page 167...
... . ADAP (AIDS Drug Assistance Program)
From page 168...
... 2015. Limited access to new hepati tis C virus treatment under state Medicaid programs.
From page 169...
... 2014. Restrictions to HCV treatment in state Medicaid programs.
From page 170...
... 2007. Policy notice-07-05: The use of the Ryan White HIV/AIDS program Part B AIDS Drug Assistance Program (ADAP)
From page 171...
... 2014. AIDS Drug Assistance Programs (ADAPs)
From page 172...
... 2006. Fact, fiction, and fairness: Resource allocation under the Ryan White CARE Act.
From page 173...
... Health Affairs Blog, June 15. http://healthaffairs.org/blog/2016/06/15/ making-hepatitis-c-a-rare-disease-in-the-united-states (accessed September 29, 2016)
From page 174...
... Hepatitis C: Screening. https://www.uspreventiveservicestaskforce.org/Page/Document/ RecommendationStatementFinal/hepatitis-c-screening#consider (accessed September 30, 2016)
From page 175...
... Morbidity and Mortality Weekly Report 64(17)


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