Louisiana Seeking 'Subscription Model' For Hepatitis C Drugs


BATON ROUGE, La. (AP) — Louisiana's health secretary thinks she's found a way to get hepatitis C drugs to more Medicaid patients and prisoners struggling with one of the nation's deadliest infectious diseases: by patterning medication purchases off the Netflix subscription model.

Health Secretary Rebekah Gee wants Louisiana to pay a monthly or yearly fee to a drug manufacturer for unlimited access to its hepatitis C medication. The state would treat as many people as it can during the period, rather than pay a per-patient treatment price.

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Gee thinks she's successfully selling the pharmaceutical industry on the concept to lower the cost of combating the blood-borne viral infection that can cause liver failure and death. She's started a process that will have Louisiana solicit bids for the "subscription model" from drug companies next summer, after getting formal feedback from the health care industry last month.

"We're on a fast track with a goal to start this model in the next year and a half," said Gee, a medical doctor.

The Centers for Disease Control and Prevention says hepatitis C kills more Americans than any other infectious disease. The CDC said deaths associated with the disease reached an all-time high of 19,659 in 2014. They numbered 18,153 in 2016, the CDC said.

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Louisiana has an estimated 35,000 people with the disease on Medicaid or in prison, relying on the state for care. But with the high price for hepatitis C drugs, most go without treatment because the state restricts who receives medication to the most severe cases.

A course of the medication, Gee said, costs "the price of a car," about $20,000 to $30,000. To treat and effectively cure everyone in the state's care with hepatitis C would carry a price tag around $760 million, not exactly a reachable expense in the poor state.

Louisiana spends $35 million on hepatitis C treatment annually, Gee said, enough to cover fewer than 3 percent of Medicaid patients and 1 percent of prisoners with the disease.

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"Show me how to solve this equation. I have a $760 million problem, and I have $35 million," she said. "In my view, we can't solve the equation as it is. We have to rewrite the equation."

Louisiana needs federal approval for the change in Medicaid prescription drug spending. Gee said leaders of 10 other states want to mirror the subscription concept if Louisiana wins approval.

PhRMA, the trade group representing major drug companies, wrote to the health department that it supports "state efforts to explore voluntary alternative financing arrangements, such as a subscription payment model."

Only three companies produce hepatitis C drugs. Gee said based on her talks with them, she expects they'll all compete for the subscription model contract when bids are solicited. Two of the drug manufacturers — Gilead Sciences and AbbVie — formally responded to the state request for information, but only Gilead directly backed Gee's idea.

"A Medicaid subscription model for cures could create predictable expenditures for the state while ensuring broad access as part of (a hepatitis C) elimination campaign," the company wrote in its response, which was released online Friday in redacted form.

Not every respondent embraced the idea of a subscription model.

A New Orleans doctor raised concerns about having enough medical staff and providers to distribute hepatitis C treatment to thousands more patients. The nonprofit AIDS Institute said Louisiana isn't providing adequate hepatitis C care to Medicaid patients or prisoners and pursuit of a subscription model "will continue to delay access" further.

Gee said she's working with health experts on logistics, identifying patients and having the clinical capacity to treat them. Her goal is to reach one-third of the hepatitis C patients in the Medicaid and prison populations by 2022.

"This is a state with limited resources trying to think outside of the box about how to improve health," Gee said. "It's still not a slam dunk, but I'm 100 percent hopeful."


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