People Who’ve Injected Drugs Deserve Hep C Treatment, Too

When the first direct-acting antivirals for hepatitis C were developed, in 2011, the price tag was steep. A single pill could cost $1,000, which added up to $84,000 for a 12-week course of treatment.

For this reason, says Harrington, many insurance companies imposed strict rules for who could be treated with the potentially lifesaving medication. Some required the person to have advanced liver disease before granting approval. Others required pre-authorization from a doctor, making it possible for a claim — and then the appeal — to be denied. Even if the company didn’t deny the claim, the red tape slowed down the treatment process, according to a study published in PLoS One.

These restrictions spanned the health insurance industry, but state Medicaid programs — which cover many people with substance use disorders — had the most limitations.

Even today, people who have private health insurance are more likely to be treated for hepatitis C than those who have Medicare or Medicaid. According to CDC statistics, someone with Medicaid is 46 percent less likely to receive timely treatment than someone with private insurance.

While many of these barriers have been removed over the years, some state Medicaid programs have yet to let go of sobriety requirements for people who inject drugs, says Harrington. “The view is that the patient has to be clean and sober in order to be eligible for treatment, and that’s backward thinking,” she explains.

In seven states, doctors have to counsel their patients about substance use issues before they can treat them. In three states, people have to abstain from alcohol or drugs for a period of time — usually six months — before they can receive treatment.

This, despite the fact that research shows people who inject drugs are just as likely to be cured of hepatitis C after taking antiviral medication as people who don’t inject drugs.

In fact, a study published in Clinical Infectious Diseases found that even when people who inject drugs miss some hep C medication doses or stop taking the treatment temporarily, they’re still likely to be cured of the virus.

Given the high cost of antivirals, some doctors choose to deny hepatitis C treatment to people who inject drugs, because they believe their patients will be reinfected with the virus, according to a review published in 2021 in the International Journal of Drug Policy.

But, while rates of hep C are high among people who inject drugs — about 53 percent will contract the virus, according to the CDC — research shows that the reinfection rate is relatively low.

One review, published in Clinical Infectious Diseases, found that only about 15 percent of people who are considered at high risk for reinfection — including people who continue to inject drugs — actually get the virus again. Among people without high-risk behaviors, the reinfection rate was closer to 1 percent.

One reason for the low rates of reinfection, says Harrington, is that people who’ve been treated for hepatitis C are more careful about sharing needles or other equipment that might transmit the virus.

“They’ve been there, seen that, and they don’t want to go there again,” she says.

There are also ways to reduce the odds that someone will continue to use drugs after they’ve received a hepatitis C diagnosis, Harrington adds. “If we offer them mental health services and medications that can help reduce substance use disorder, we can cut the reinfection rate by about a third.”