Take Note, Washington: Louisiana May Be on to Something

These days, when you see a Democrat and Republican working together on a health care solution, it is important to take note. Most likely, something good is happening.

In this case, the bipartisan effort driven by two public servants, who are also physicians, is resulting in an innovative proposal to confront the costly public health challenges associated with the hepatitis C virus.

HCV is the most common blood-borne disease in the United States. It can be deadly, as well, if left untreated, killing more Americans than any other infectious disease. With the unfortunate rise in heroin use, the disease is spreading rapidly.  

Research by the Centers for Disease Control and Prevention found that new hepatitis C cases tripled between 2010 and 2016. Currently, more than 2 million Americans are infected by this virus, with California, Texas, Florida, New York, Pennsylvania, Tennessee, Ohio and Washington accounting for more than half of the cases in the United States.

The good news, however, is that treatments providing a cure for this potentially deadly disease have been on the market for five years, and hundreds of thousands of lives are now being saved. More importantly, patients who have received these new treatments are spared the complications and costs associated with chronic hepatitis C infections, and they remain healthy and productive. In addition, treatment prevents them from transmitting the disease to others.  

Now for the bad news: HCV is costly to treat. Only three companies produce hepatitis C drugs, and the cost of the recommended 12-week regimen puts the cure out of reach for many who need it. The traditional prescription drug insurance model that requires a patient to pay a percentage of the cost of the drug fails because even that percentage is unaffordable.

For those who rely on programs such as Medicaid, budget constraints make the cost unaffordable to states, forcing them to limit treatment to only the sickest patients. According to a recent JAMA article, only 15 percent of individuals with HCV infection in the United States have been treated.

No longer satisfied with the status quo, Rebekah Gee, health secretary for Louisiana’s Democratic governor, and U.S. Sen. Bill Cassidy (R-La.) are on a mission to eliminate HCV from Louisiana, where an estimated 35,000 people on Medicaid or in prison have the disease.  If we can eliminate polio, why not HCV?

Gee and Cassidy propose negotiating with the manufacturers of the drug to reach a solution that would generate profits for the pharmaceutical company, help Louisiana contain its health care spending, and ultimately wipe out HCV in Louisiana, improving the lives of thousands of Americans.

The proposal would replace the piecemeal approach of a per-patient, per-treatment fee with a subscription-based model — think Netflix. A coalition of payers (state, federal and private insurers) would negotiate a monthly or yearly subscription fee with the manufacturer for unlimited access to its drugs to treat infected citizens. This would be comparable, in a health care setting, to paying a flat fee to Netflix’s video-streaming service that provides unlimited content.  

There are still details to be worked out, but shifting health care funds from treatment to prevention and cure of hepatitis C makes sense for all of the parties involved. States and other insurers could face a more manageable and predictable expenditure while eradicating this disease and reducing future costs.

The pharmaceutical company would eventually realize a profit for its HCV treatment, fueling future research on additional medications. Given these potential win-win-win outcomes, the concept is receiving widespread endorsement from groups like the National Governors Association.

Louisiana, however, cannot go at this alone and will need the cooperation of other insurers and federal support from the Centers for Medicare and Medicaid Services before it solicits competitive bids from the drug manufacturers to participate in the program. CMS’ Center for Medicare and Medicaid Innovation has the authority under its State Innovation Models Initiative to implement this plan and should make it a priority.

The Louisiana approach addresses a situation in which high drug prices make treatment inaccessible to the people who need it most. With support from both sides of the political spectrum, it is a plan that deserves attention and, if successful, would be a model for other states. There would clearly be financial benefits, but the real beneficiaries would be the thousands of people in Louisiana who are struggling with this potentially fatal disease and deserve the life-saving treatment that is now beyond their reach.


Jim Scott is a Republican who served as a senior legislative adviser at the U.S. Centers for Medicare and Medicaid Services during the George W. Bush administration, and he is the president and CEO of Applied Policy, a health policy and reimbursement consultancy in Alexandria, Virginia.

Shane Doucet served as an aide to former blue dog Democrat Rep. Chris John (La.), and he currently serves as principal of Doucet Consulting Solutions LLC, a public policy firm.

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