Provincial funding for hepatitis C drugs a game changer, health professionals say

The Ontario government says it willcover the cost of medication for all hepatitis C patients, regardless of the severity of the disease, a movethat's being touted as a game-changing decisionby health professionals in the field.

Prior to the changes made to the Ontario Drug Benefit (ODB) program on Feb. 28, only patients in the late stages of liver disease could be approved for the expensive treatments. Vulnerable patients like pregnant mothers could also be covered.

"Due to significant costs ($45,000 to $100,000per patient), hepatitis C drugs were previously restricted," stated Ministry of Health and Long-Term Care spokesperson David Jensen in an email.

Jensen saidthe changes were spurred by the newfound availability of minimally invasive drugs with very high cure rates.

"The new medicines for hepatitis C have the potential to be curative, avoiding the complications associated with chronic hepatitis C infection," said Jensen.

There are currently eight drugs approved to treat hepatitis C under the province's drug benefits program.

'Final piece of the puzzle'

Dr. Paul Marotta believes the changes mark a critical turning point for treatment of the disease.

He's a hepatologist and the medical director of the liver transplant program at the London Health Sciences Centre.

"This is probably hopefully the final piece of the puzzle," says Marotta.

He notes that for decades, available hepatitis C treatments were long, complex and had low success rates. He says that's now changed.

"In the last several years, we've been able to access some products which are in pill form, very short duration, meaning three months of one pill once per day, almost no side-effects, almost 100 per centcure rates," explains Marotta.

He's convinced the fact patients can now receive subsidised treatment early on in the disease will go a long way to saving lives.

"It's always been this logical thinking from the patient's perspective: Why do I have to get worse before I get better?" explains Marotta. "The reason for that is there's a limited budget and [physicians]wanted to apply treatments to those most in need first."

He adds that the results gave the government an easy choice to make.

"The negative outcomes of hep C, meaning cirrhosis, liver cancer, the need for liver transplants, we just don't see them as much anymore," notes Marotta.

Though he's based in London, Marotta makes four to six trips each year back to his hometown of Sudbury, where he sees about 100 patients annually.

He says there used to be a lack of access for liver-related disease treatment in northern Ontario and rural areas, but that the recent fight against hepatitis C has reduced that need.

"The local doctors have been taught and trained to [diagnose and prescribe treatments for hepatitis C], so the necessity for me to go there is a little less, but I still go there to be a resource and for perhaps more complicated cases," says Marotta.

Eradicated by 2030?

Canada's federal government has also stated its belief in the treatments, having committed to rid the country of hepatitis C by 2030.

Dominica Anderson believes that's an ambitious goal. She's an outreach nurse with Reseau ACCESS Network in Sudbury, a non-profit organization services people without private insurance or work benefits, offering testing and counselling for hepatitis C and other diseases.

Still, Anderson says she was relieved and pleased about the Ontario's government's recent changes.

"Hearing the restrictions have been lifted was really good because we were kind of forgetting about our healthy young (clients) who have contracted the virus," notes Anderson.

"Instead of telling them you have to get sicker or you need to wait for medications to be available, now we can treat people, it's easier, and we don't have to push anybody aside."

Two-pronged education

In concert with the changes, the province's funding for hepatitis C medication will increase to its highest-ever level, to an estimated $425 million in 2017-18.

That's compared to $225 million in 2016-17, according to the MOHLTC. In 2012-13, prior to the influx of new drugs available on the market, Ontario's funding for hepatitis C medication totalled only $19.7 million.

Marotta is adamant the increased cost is worth it, especially if it leads to anything resembling the eradication of hepatitis C in the province.

Part of the problem, he adds, is that many of the estimated 250,000 people who have contracted the disease don't know they have it.

"Now we're out there trying get the message across to those individuals who already know they have hepatitis C but haven't come back to clinic because they weren't available for treatment," says Marotta.

"There's also the group that doesn't even know they have hep C, so there's a two-pronged education."