Backed by increased funding from Congress, the VA announced that it would now cover hepatitis C (HCV) treatment for all veterans. The VA estimates that there are 174,000 veterans with HCV infection and that it could spend about $1 billion to treat these veterans in fiscal year (FY) 2016 alone. Previously the VA had limited access to the new generation of expensive oral direct-acting antivirals (DAAs) that promised to cure HCV for most veterans.
“To manage limited resources previously, we established treatment priority for the sickest patients,” said VA Under Secretary for Health Dr. David J. Shulkin in a statement. “If veterans are currently waiting on an appointment for community care through the Choice Program, they can now turn to their local VA facility for this treatment or can elect to continue to receive treatment through the Choice Program.”
Although the VA has promised to treat all infected veterans, according to a February 2016 memo, it is still advising health care providers to prioritize those with more advanced liver disease. The memo also pointed out that funding will not be available for additional staffing or laboratory testing, but departments should “ramp up treatment to the maximum possible capacity. Managers should ensure that adequate clinical resources…are allocated to clinics providing HCV treatment to allow full utilization of funding for HCV treatment.”
The VA expanded its available treatment options for HCV in addition to the previously approved DAAs daclatasvir/sofosbuvir and ombitasvir/paritaprevir/ritonavir plus dasabuvir regimens. The VA Pharmacy Benefit Management Services also released a new Criteria for Use and drug monograph in January 2016 for the recently FDA-approved DAA elbasvir/grazoprevir.
The VA has treated more than 76,000 veterans infected with HCV and cured about 60,000. Last year, the VA was forced to return to Congress to request additional funding for HCV treatment. In FY 2015, 17% ($696 million) of the VA pharmacy budget went to HCV treatment.