National Hepatitis C Screening Rate Low Despite Widespread Need

The U.S. Preventive Services Task Force (USPSTF) has made a B-level recommendation that all young adults and adolescents should be screened for hepatitis C, which has become more prevalent in the wake of opioids substance abuse.

“Hepatitis C affects millions of people across the country,” Michael J. Barry, MD,
a task force member, said in the bulletin. “We recommend screening all adults regardless of their risk because new evidence shows that more people can benefit from this service than ever before.”

The number of hepatitis C cases is nearly four times what it was a decade ago. 

The opioids substance abuse crisis is thought to be a significant contributor to the high rate of infection among young adults. Kentucky, Tennessee, Virginia, and West Virginia are all states that have been deeply affected by the opioids crisis. These four states also saw a 364 percent increase in hepatitis C infections between 2006 and 2012.

When the disease combines with a chronic liver condition, it can be deadly. In fact, this blood-borne disease kills more Americans than the nation’s 60 other most infectious diseases combined. That list includes HIV.

Due to the heightened risk, the USPSTF’s policy has broadened its recommended demographic for screening, as published in JAMA. The new policy suggests that a one-time screening should be conducted on most adults, with their consent. 

The age range used to be only those born between 1945 and 1965, but now the USPSTF says that anyone ages 18 to 79 years old and those with risk factors outside of that age range should be screened.

The task force pointed out that some payers, the Veterans Health Administration, and some academic medical centers are highly successful at conducting screenings.

But on the whole, the national screening rate for patients is very poor. Only 8.3 percent of community health centers conducted hepatitis C screenings and a little over 17 percent of participants in the National Health Interview Study were screening for hepatitis C, USPSTF said in the JAMA article.

A quarter of the primary care providers serving low-income, under-, or uninsured communities screened less than one percent of their population born between 1945 and 1965 in compliance with the task force’s previous recommendation.

Other studies have demonstrated that private payers have not made sufficient efforts to cover hepatitis C treatment.

Over 50 percent of private payers did not provide coverage for hepatitis C treatment according to a study conducted from 2014 to 2017. During that same time period, public payer access to the treatments was also restricted.

With the broader demographic that now needs to be screened, failure to pursue population-wide screenings could have serious implications.

“People with hepatitis C do not always feel sick and may not know they have it,” said Douglas K. Owens, MD, the chair of the task force, in the bulletin. “Screening is key to finding this infection early, when it’s easier to treat and cure, helping reduce illnesses and deaths.”

Without question, hepatitis C treatments are expensive. This deters many payers from absorbing the costs.

However, instead of shying away, some Medicaid programs are creating opportunities to cover the treatments through alternative payment models.

Louisiana’s Medicaid program uses a subscription model to pay for hepatitis C therapies. Approved midyear in 2019, Louisiana’s Medicaid program negotiates a supplemental rebate with prescription drug manufacturers. The state has unlimited access to the drug and the price is capped. Louisiana pays the manufacturer back in increments, instead of in one lump sum.

Before Louisiana’s subscription model came Washington state’s value-based reimbursement model. In Washington, where hepatitis C affects the lives of approximately 30,000 people on state healthcare plans, the state and manufacturers can hammer out a value-based reimbursement agreement within the bounds of a certain template. The template may hinge on certain requirements such as a utilization period or outcomes-based benchmarks.

Private payers may begin to follow suit as the need for hepatitis C screenings and treatment becomes increasingly dire.