Friday, September 30, 2016

On eve of rollout, fears under-funding may restrict hep C treatment

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On eve of rollout, fears under-funding may restrict hep C treatment
Friday 30 September 2016, 3:20PM

The RNZCGP fears under-funding threatens a ground-breaking hepatitis C treatment even as GPs prepare to start prescribing it from tomorrow.

The college has written an urgent letter to the Ministry of Health saying it supports the treatment, but extensive GP input is needed and the cost “will have a significant impact on patient’s ability to obtain a cure”.

It is urging the ministry to consider funding options, including direct funding for free GP visits.

GPs have been preparing for three months for the rollout of Viekira Pak, shown in trials to cure more than 95 per cent of patients with hepatitis C genotype 1. The drug was financially out of reach for most people, until it was funded by Pharmac from 1 July.

Patients will be knocking on GPs’ doors

Pharmac and drug company Abbvie have been preparing GPs for the rollout with educational materials and seminars. Pharmac’s deputy medical director for primary care, GP Bryan Betty, says it is one of the biggest changes in general practice prescribing in decades.

Auckland liver specialist Ed Gane says GPs should expect to have patients “knocking on their door” from tomorrow.

“GPs need to ensure they are educated about this new treatment,” Professor Gane says in a media release. “This is our chance to offer a life-changing cure to many people living with hepatitis C.”

College endorses training but queries cost

RNZCGP chief executive Helen Morgan-Banda is in Australia today and unable to be interviewed. She sent an email saying the college is endorsing both face-to-face training via DHBs and an online module for GPs prescribing Viekira Pak. It is also promoting the training via its weekly e-newsletter to members.

Ms Morgan-Banda wrote to the ministry last Friday saying the college welcomes the new treatment as a great development that will have positive benefits for a large number of New Zealanders.

But she says the college is very concerned the cost of GP visits will present a barrier to patients. She suggested two alternative avenues for funding:

* direct funding for free visits, such as the ministry currently provides for dioxin exposed people, and

* funding through a DHB Primary Options for Acute Care (POAC) programme.

“Our view is that whichever model is deemed appropriate, action needs to be taken urgently to ensure that it is in place and funding is available as soon as possible after the 1 October date when access to treatment becomes available,” she wrote in the letter.

In today’s email, Ms Morgan-Banda says the medicines have been funded, but GP appointments have not. The college is concerned this will affect the success of the programme.

She says patients with hepatitis C tend to be more deprived than the general population and are also often transient. She is concerned the lack of funding will result in inequity of access to treatment.

New Zealand Doctor sought comment from the ministry, but did not receive a reply before deadline.

‘Game-changing’ – despite the cost

ProCare associate clinical director and GP Jamie Shepherd says the issue of cost has been discussed at the PHO and he understands why the college has concerns.

But he says he and colleagues are well prepared and excited about being able to offer the treatment.

“We would love to have it funded, but we recognise as a GP it’s our role to deliver this as best we can. We have been aware of the rollout since July. It will be a big change for general practice, but it’s been well highlighted.

“This is game-changing for people with hepatitis C in New Zealand.”

Huge improvement in treatment

Professor Gane is hailing the new drug’s efficacy. Viekira Pak is taken orally, usually for 12 weeks and will cure over 95 per cent of patients, he says. It is also well tolerated, with 99 per cent of people completing treatment.

“This is a huge improvement compared to previous Interferon treatments, which consisted of weekly injections for a year, associated with bad side effects. Almost 20 per cent of people had to stop the treatment and less than half were cured.”

However, he says an effective oral treatment is still needed for almost half of the New Zealanders infected with hepatitis C who have other genotypes (2, 3, 4, 5 and 6).

Buyers’ Club an option for some

He is calling for Pharmac to fund other pan-genotypic drugs, but says in the meantime personal importation of generic versions could be a viable option.

He says to date more than 500 New Zealanders and Australians have accessed generics through the Fix Hep C Buyers’ Club run by Australian GP James Freeman.
“The generic medications cured more than 95 per cent of patients and were extremely safe, proving that these generic drugs are the real deal,” Professor Gane says. “These medications cost less than five per cent of the price of brand drugs — which is about $2,100.”

Related link
October 1: a momentous day for many people living with hepatitis C in New Zealand - The Hepatitis Foundation of New Zealand

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