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2016 Congress Spending Bill Disses HCV Again
  Jules Levin, NATAP
Apparently today Congress released the Fiscal Year (FY) 2016 Omnibus Appropriations Bill. Expected cuts to HIV were not made & in fact HIV received deserved increases, which is great. The VA will receive $1.5 Billion or HCV drugs/treatment, which of course is also great. I won't commend Congress though because of their continuing disregard for the Hepatitis C problem. The actual Budget for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention is on page 12 where you can see $34 mill is being provided to the CDC for HCV, this is essentially NO INCREASE, Congress increased funding by pittance $2.7 million. The President recommended $32 million increase which stinks too, and the Senate recommended $5 million increase. Other diseases I think received increases including Alzheimers & deservedly so, but what about HCV. Diabetes & heart disease is well funded so is cancer, despite that recent & new cancer drugs are very costly in the range of $100,000 per year despite not providing a cure, and the recent LDL cholesterol drugs are very expensive, if all eligible were treated it could cost $150 Bill a year, and of course this is an annual cost because its not a cure either. So why does HCV get dissed, I have some thoughts I won't put in this report but clearly HIV drugs used to receive a lot of attention and now the same companies are making HCV drugs and they are receiving a lot of attention. Medicaid officials targeted new HCV drugs 2 years ago when Harvoni & Viekira Pak were approved and the drug makers Gilead & Abbvie provided rebates & discounts amounting to 50% discounts, still federal and state Medicid officials have not budged an inch regarding reducing the restrictions & funding HCV programs like screening, linkage to care, prevention etc. In the spring the White House announced they supported Medicare paying for $100,000 cancer drugs. The new LDL cholesterol drugs I don't think are getting as much scrutiny as the HCV drugs but they have received some scrutiny, still they just recently launched so lets see what kind of restrictions if any are placed on these new drugs. Value-based pricing is the new kid on the block, for example "pay for cure" in HCV where Medicaid could pay for if a patient is cured but not if the patient is not cured. This was implemented in Scotland last year and Portugal made a deal with Gilead that included similar arrangements. There are various types of value-based pricing and several deals in other diseases have been cut over the past several years between insurers and drug makers, but much more consideration is due regarding value-based pricing.
The agreement provides a significant
increase to support Diabetes, Heart Disease and Stroke prevention.
Opioid Prescription Drug Overdose (PDO) Prevention Activity.-The agreement commends CDC for its leadership in expanding efforts combatting prescription and opioid drug overdoses. The agreement directs the CDC Director to implement these activities based on population-adjusted burden of disease criteria, including mortality data (age adjusted rate), as significant criteria when distributing funds for the State POO Prevention activities. The CDC is expected to adhere to the conditions identified in the fiscal year 2015 Appropriations Act and explanatory statement as CDC expands beyond prescription drugs and into the broader category of opioids. The agreement assumes these funds will be distributed via a competitive mechanism and not merely a mathematical formula or standard allocation to each State.
Surveillance of Heroin.-The agreement directs CDC to expand surveillance of heroin-related deaths beyond CDC's current work in HHS's Region 1 and to require applicants for the PDO Prevention for States Programs to collaborate with the State's substance abuse agency or agency managing the State's Prescription Drug Monitoring Program.
Page 39:
Curing Hepatitis C within the Veteran Population.-The Department is to be commended for robustly treating veterans with Hepatitis C (HCV), which is a particular concern because the veteran population is twice as likely to have the virus as the general population. VA has developed a Hepatitis C projection model, which is able to project both the prevalence of HCV infections within the enrolled veteran population and the number of treatments needed from 2014 through 2023. Available HCV drugs have a cure rate of96 percent, and early, preventative treatments avoid tens of thousands of dollars in future spending on transplants and chemotherapy. To that end, the agreement includes bill language funding the treatment of Hepatitis C within the VA system at no less than $1,500,000,000 in fiscal year 2016, which is $810,000,000 above the President's request.
To assist in congressional oversight, VA is directed to report to the Committees in quarterly briefings the number of veterans treated to date, the number of veterans treated each week, the number of veterans pronounced cured to date, the projected number of new cases, and the estimate of veterans likely to be cured during the next quarter. In addition, VA should indicate in a report sent to the Committees not later than 90 days after enactment of this Act the Department's volume capacity for treatment and the Department's strategic plan for addressing the veteran Hepatitis C caseload over the next five years. VA is also directed to report quarterly to the Committees obligations for funding Hepatitis C treatments as part of the larger crosscutting VA quarterly financial report required in section 219.
Pages 26 and 27

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