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CBO Statement: "Budgetary Effects of Policies That Would Increase Hepatitis C Treatment", creates impossible unique barrier to eliminate HCV
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From Jules Levin: Federal CBO Budget Impact Evaluation Sets Too High Standard & Burden, It seems AS If they want to Create an Impossible Set of Standards to Support a Federal HCV Elimination Program, an excuse to make sure a Bill does NOT pass Congress. In this scenario I do not think Senators Van Hollen & Cassidy will submit their HCV Elimination Bill to Congress. The HIV Ryan White Care Act nor other federal HIV/AIDS expenditures & large funding programs are subjected to this much scrutiny & requirements.
Here are some of their absurd comments & requirements.
June 14, 2024
Report
CBO describes its initial analysis of the potential federal budgetary effects of policies that would increase treatment of hepatitis C, focusing on two sample national policies that would increase treatment rates among Medicaid enrollees.
https://www.cbo.gov/publication/60237
As of 2020, the average total cost of a course of DAA treatment was $11,500 to $17,000, depending on the specific DAA medication (across payers and net of pharmacy discounts, patient assistance, and rebates and coverage-gap discounts in Medicare).14
The states of Louisiana and Washington implemented subscription models for treating hepatitis C with DAAs in their Medicaid programs in 2019.20Both states' programs were designed to pair the new payment model with increased outreach and public awareness. Results from those programs were mixed. The number of people treated in Louisiana increased by 450 percent in the program's first quarter but has since dropped steadily. In Washington, the subscription model did not change the preexisting downward trend in the treatment rate.21 Both efforts were hampered by the pandemic and a lack of funding for outreach and related public health initiatives.
The effects of a national hepatitis C treatment program on federal spending would depend on the specific details of the policy. Much of the cost of such a program would be spending on DAAs. Under the existing payment system, by CBO's estimate, higher treatment rates would increase federal Medicaid spending by about $0.5 billion in the first scenario (a 10 percent peak increase in treatment rates) and by about $4 billion in the second scenario (a 100 percent peak increase in treatment rates) over the 2025–2034 period.
Higher treatment rates could also be funded in other ways. For example, an enhanced federal matching rate could be established for testing and treatment of hepatitis C, meaning that the federal government would pay a larger share of that spending for Medicaid enrollees. Alternatively, a federal program to procure DAAs for Medicaid enrollees could follow state programs and establish a federal subscription model to procure DAAs at a fixed cost determined by negotiations between drug manufacturers and the Secretary of Health and Human Services. Legislation that created a federal subscription model with appropriated funding could cover treatment occurring under current law as well as additional treatment. In that case, state and federal Medicaid spending on treatment occurring under current law would be shifted to the federal subscription model.
By improving health outcomes, an increase in hepatitis C treatment could also affect the federal budget in other ways—for example, by leading to improved longevity and lower rates of disability. Improved longevity would increase outlays for various federal programs that subsidize health insurance, for retirement benefits provided by Social Security's Old-Age and Survivors Insurance (OASI) program, and for disability benefits provided by Social Security's Disability Insurance (DI) program and the Supplemental Security Income (SSI) program.29 Lower disability rates would reduce outlays for the DI and SSI programs, Medicaid, and Medicare.30
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