I’ve been away from this blog for a while. That’s good news for people who have hepatitis C. I was among the first few patients to receive direct-acting antivirals in 2014. Within six weeks my viral count was nearly nothing. In six months, it was nothing. In another six months, my liver, which had been on the edge of cirrhosis, was back to normal.

The good news about dragging my feet on writing this blog? It’s that a few years after being cured some people can almost forget that they ever had hepatitis C. *

Occasionally, though, something brings the disease back to top-of-mind. That happened today, and it was good news.

An anti-viral under development in Egypt purports a 100 percent cure rate. Better yet, the price of the 12-week treatment from Pharco Pharmaceuticals is predicted to be $300. Think of the progress in that! When I was treated, Gilead Sciences set a $120,000 price tag on my drugs. My book, Demon in My Blood, reveals that the cost of production was actually more like the $300 drug being developed today.

Better news may come in a decade. The World Health Organization vows to eradicate hepatitis C from the earth by 2030. If so, the drugs will cost nothing.

 * Many people suffer lingering effects after being cured of hepatitis C. I’ve written about their struggles in the past and hope for their full return to health.

Today I have a few updates about drug coverage in some English-speaking countries:

• For more than a year in Australia, the government’s Pharmeceutical Benefits Scheme has been charging low-income patients $5.30 for treatment with direct-acting antivirals. Other Austrailians pay only $37.80 for a treatment. A family physician or nurse practitioner can prescribe the drugs in consultation with a gastroenterologist or hepatologist specialized in chronic hepatitis C infection.
• Residents of the United Kingdom await better coverage of drug costs for hepatitis C. Last year the National Health Service limited its coverage of the hep C miracle cures to 10,000 patients per year, whereas 160,000 people in the UK were infected with hepatitis C. A spokesman for the NHS said, “As prices come down we hope in future years to be able to expand treatments even further. . .”
• Canada, where each province runs its own drug plan, has been seeing better coverage for hepatitis C antivirals. British Columbia, for example, has announced that treatment for everyone with hepatitis C, no matter their degree of liver damage, will be covered by its Fair PharmaCare plan starting in 2018. Under the plan, patients pay a deductable, depending on their income. After paying the deductible, they pay 30 percent of drug costs to a maximum amount. At that point the plan pays everything. For example, a hepatitis C patient with a family income of $50,000 a year would pay a total $1,650, including the deductible and 30 percent payment. The plan would pay everything after that.
• In the United States, drug plans and Medicaid may not cover hep C treatment for all levels of fibrosis. The big worry there recently has been the repeal of the Affordable Care Act and the Senate’s proposed replacement, which could allow States to alter their rules so that pre-existing conditions may preclude coverage. Hepatitis C can hide in the system for decades, until it emerges as a pre-existing condition.

Blog readers, please let me know the news from your location.

Gilead Sciences in Japan has decided to change the packaging of Sovaldi and Harvoni in that country. The direct-acting antivirals will now be sold in blister packs rather than bottles, which would make it harder for counterfeiters to scam patients who have hepatitis C.

This comes soon after Japan’s  health ministry announced that phony Harvoni tablets had  been found in drugstores in Nara Prefecture. The false drugs were sold in three stores, all part of the same drug store chain. The bogus Harvoni  tablets were discovered when a patient questioned the odd shape of the pills, which were different in colour and shape from the standard orange Harvoni tablets. The bad pills had been placed in actual Harvoni bottles.

Gilead has investigated the counterfeit drugs and has announced they have not caused any health problems. But presumably there were no cures. That must have been extremely disheartening to patients who took the phony pills. It’s almost worse than not being able to afford the real ones.

Australia recently became the first country in the world to make direct-acting antivirals free for all of its citizens who have hep C and are at any stage of fibrosis. The government health plan pays for the drugs.

Anyone who has hepatitis C and holds a Medicare Card (every Australian citizen gets one) can be treated though their general practitioner. The process is simple. After a person tests positive for HCV, their doctor consults with a hepatologist or gastroenterologist and writes the prescription. It doesn’t matter how high—or low—the person scores on a Fibroscan.

The country’s Prescription Benefit Scheme pays for the drugs. The patient pays either a $6 or a $38 dispensing fee, depending on income.

The unfettered, virtually free DAA treatment policy was introduced in March after intense campaigning from Hepatitis Australia and other advocacy groups.

Despite the demise of interferon, the debilitating drug that was used for two decades to treat hepatitis C, many patients must still deal with one component of the old treatment. Under the brand names CoPegus and Rebetol, ribavirin is sometimes prescribed in addition to direct-acting antivirals. Doctors most often prescribe it for difficult cases of hep C.

The difficult cases include patients with cirrhosis. Recent studies show that ribavirin combined with DAAs can reduce the length of treatment for many of these people (see Ribavirin: Past, present and future).

Ribavirin’s common side effects include anemia, insomnia and irritability. For some patients, the side-effects can be mild. Many doctors feel they are a small price to pay in exchange for big drug prices patients can’t afford. Twelve weeks of a DAA plus ribavirin instead of 24 weeks of a DAA alone could save a patient many tens of thousands of dollars. Ideally, patients and doctors shouldn’t have to think about that. But they do.