The Cost of Treatment

Going on the Standard of Care Hepatitis C Treatment of Pegylated Interferon and Ribavirin that is paid for via your insurance plan or out of your own pocket, causes a major restructuring of you financial budgets. The meds to treat Hep C are not cheap. Pegylated interferon is a relatively new drug and thus does not have a generic version available. It is available only via brand name preparations. As anyone dealing with drugs knows, brand name is always more expensive than generic. Ribavirin is a bit of a different story. It is available in generic form as well as brand name and thus is available at a lower cost, but that lower cost is not necessarily cheap.

None of this is news to anyone who approaches the treatment through their hepatologist and insurance company. For those folks, the cost of treatment has been a major component of their decision whether or not to even begin the process. For people who have been involved in research trials where the drugs are provided free of charge by the drug company sponsoring the research plan, it is a rude shock. Complicating the situation is the fact that people entering treatment through their insurance company or via their hepatologist have been thinking long and hard about the cost of the treatment, they have been making plans as to how to pay for it. They may have contacted the drug companies if they are underinsured or uninsured to see whether they qualify for any financial assistance. In short they have been thinking about it seriously for a considerable time.

When you suddenly make the decision to continue treatment through you insurance or out of your own pocket in order to try to continue the gains you have made during the research trial, the cost issue is thrust upon you without a real chance for reflection and planning. You find out that Pegylated interferon is runs up to $550 per dose; That a months supply of Ribavirin might be $1000; making the monthly bill over $3000 if you are paying for it yourself. Even if your insurance is paying for some of the cost of the drugs, it might not be for the same prescription co-payment you have grown used to with the other drugs you have received over the years.

In my case, I am already on 5 drugs to manage the side effects of the interferon and ribavirin, they are Celexa, Trazadone, Levothyroxin, Ativan and Tramadol. I don’t take all of them every day and the scrips run for various lengths but it is safe to say that the co-payment bill is $60 per month for those 5. As we have hustled to continue the Standard of Care treatment without interruption to the dosing schedule, we have heard several different numbers for the co-payments for Ribavirin and Pegasys (which is the drug that is on my insurance company formulary). It started out being a flat 20% of cost or $450 per month, then was reported to be $165 per month, then a test payment run by the specialty pharmacy supplying the Pegasys reported it at $250 per 4-week supply. The ribavirin will be covered at the standard $15 per prescription copay. So what it looks like is that it will cost from $325 per month for the 7 drugs in question up to $525 per month under the worst-case scenario.

In easy to understand terms, it means from $3900 to $6300 per year for the drugs that will give me at best a 40% chance to clear the virus; about $100 per percentage point of potential success. And this does not include any additional drugs which may be prescribed to counteract the low blood cell counts caused by the interferon and ribavirin. This is yet another reason that some people wait years to undergo treatment. It can be hugely expensive.

More on the personal costs in upcoming posts.