HJBR Nov/Dec 2019

Healthcare Journal of Baton Rouge  I  NOV / DEC 2019 49 Stewart T. Gordon, MD, FAAP Chief Medical Officer, Medical Affairs Louisiana Healthcare Connections The arrangement, dubbed the “Netflix model” of prescriptive medications, has been heralded as a model for other states by the Centers for Medicare and Medicaid Services (CMS). “The high cost of prescrip- tion drugs is one of the greatest challenges in our healthcare system, and Louisiana’s innovative approach to leveraging a sub- scription model to promote access to hep- atitis C therapy is a great example of how states can lead in designing solutions,” noted CMS Administrator Seema Verma in a press release announcing the agency’s approval of Louisiana’s strategy. The Five-Year Plan The 2019–2024 Hepatitis C Elimination Plan, known as the Five-Year Plan, is cen- tered on the state’s modified subscription model for these hepatitis C direct-acting antivirals, or DAAs. The department’s goal is to treat at least 10,000 Medicaid-enrolled and incarcerat- ed individuals by 2020, with the ultimate objective of eradicating the disease and halting its spread, while supporting a sus- tainable budget. “An elimination plan and innovative payment model will ensure that we can cure this deadly disease and prevent long- term illness and disability in those who have it,” LDH Secretary of Health Rebekah Gee, MD, said in a statement. This plan has a number of core strategic priorities, including prevention and risk re- duction education; streamlined treatment; improved disease surveillance; increased access to harm reduction and substance use disorder services; and provider train- ing and support. A centerpiece of the plan, however, is expanded screening for priori- ty populations, according to the LDH. “This plan is ambitious and can only be achieved by implementing systematic changes to reduce incidence and preva- lence of HCV across the state,” the depart- ment stated in a call for public comment about the Five-Year Plan. Hepatitis C Screenings As physicians and healthcare profes- sionals in Louisiana, we have an opportu- nity to support the state’s efforts to erad- icate HCV by performing screenings to ensure early detection and treatment of the virus. HCV screening is a simple process in which a blood sample is tested for the anti- bodies that react specifically to the hepati- tis C virus, followed by a second test to de- termine the level of the virus in the blood. This screening is critical in detecting the infection before it causes serious damage to the patient’s liver. According to the Centers for Disease Control and Prevention (CDC), HCV screenings are highly recommended for patients who: • Were born between 1945 and 1965. • Are currently injecting drugs, or ever in- jected drugs. • Have certain medical conditions, includ- ing those who received clotting factor concentrates produced before 1987; who were ever on long-term hemodialysis; have persistently abnormal aminotrans- ferase levels (ALT); or who have HIV. • Were prior recipients of transfusions or organ transplants, including those who were notified that they received blood from a donor who later tested positive for HCV, or received a transfusion of blood, blood components, or an organ transplant prior to July 1992. • Have high potential for HCV exposure, including healthcare, emergency med- ical and public safety workers, through needle sticks or mucosal exposures, and children born to HCV-positive women. The increased availability of DAAs to treat HCV among at-risk populations rep- resents an unparalleled opportunity to halt the spread of HCV in our state, but only with the support of physicians and health- care providers who work together to en- sure that patients are effectively screened and identified for treatment. n “The high cost of prescription drugs is one of the greatest challenges in our healthcare system, and Louisiana’s innovative approach to leveraging a subscription model to promote access to hepati- tis C therapy is a great example of how states can lead in designing solutions.” – Seema Verma Centers for Medicare & Medicaid Services Administrator