HJBR May/Jun 2019

44 MAY / JUN 2019 I  Healthcare Journal of BATON ROUGE column SECRETARY’S CORNER Several years ago, Louisiana set out to eliminate the disease to reduce pre- ventable suffering and premature death. Our journey to achieve that goal has been a circuitous one, made more challenging because Louisiana is one of the poorest states in the nation and has a dispropor- tionally infected population. Now, we are one major step closer to achieving our goal, having received offers from the man- ufacturers of the costly hepatitis C medi- cations seeking to partner with the state in a bold new approach to drug purchasing.  Costly Hepatitis C Medications Out Of State’s Reach Around the beginning of Gov. John Bel Edwards’ administration, the Louisiana Department of Health received letters from both the Centers for Medicare and Medicaid Services (CMS) and health care advocates demanding that hepatitis C medications be made more widely avail- able to Medicaid patients. Looking at the data, I realized that CMS and the advocates were right—our disease registry indicated that 90,000 people in Louisiana had the hepatitis C virus, and we were treating a small fraction of those who were infected and enrolled in Medicaid.    Providing broad access to the medi- cations that cure hepatitis C is a critical public health imperative, but has not been possible in Louisiana because of the high cost of the drugs that can cure this deadly infection. Our administration inherited a budget deficit of more than $2 billion, and spending the hundreds of millions of dol- lars necessary to treat our vulnerable pop- ulations with hepatitis C was out of reach.  Engaging The Experts To explore potential solutions, in June 2016, we reached out to the Drug Pricing Lab at Memorial Sloan Kettering Cancer Center. At our request, a team there, led by Peter Bach, created the Louisiana Budget Allocator to demonstrate the tradeoffs we Louisiana’s Journey Toward Eliminating Hepatitis C Hepatitis C is the leading infectious disease killer of our time, but it is also one of the few viruses that has a cure— direct-acting antiviral medications. faced as a state. The tool showed that to pay for the hepatitis C medications needed to treat all infected individuals enrolled in Medicaid, we would need to spend an esti- mated $760 million. That is more than the state spends on K–12 education, veteran’s affairs, and corrections combined. We also considered value-based pricing strategies, but the projected long-term savings to the state were not significant enough to justify the $80,000 per treatment price tag, espe- cially since Louisiana is constitutionally required to produce a balanced state bud- get each year.  We also contacted the drug compa- nies making the direct-acting antivirals (DAAs) that cure hepatitis C and were not able to negotiate better pricing. One day, I happened to be talking to former Food and Drug Administration Principal Depu- ty Commissioner Josh Sharfstein, now at Johns Hopkins University, and presented our conundrum to him. He proposed that we consider using a section of a 1910 patent