What Is the Best Treatment for Hepatitis C?

What is hepatitis C?

Hepatitis C, or hep C, is an infection of the liver caused by the hepatitis C virus (HCV). The virus is transmitted through the blood, most commonly through contaminated needles, but also through sex. In 75%-85% of cases, the infection becomes “chronic,” which means the body cannot get rid of it. Chronic hepatitis C can slowly destroy the liver over several decades by causing liver cirrhosis (scarring) and liver failure. It can also cause a type of liver cancer called hepatocellular carcinoma.

In the US, Latin America and Europe, the most common type of hepatitis C infection is type 1.

Here, we’ll talk about treatment options for chronic HCV type 1, which makes up 60%-75% of US cases of hepatitis C.

Can hep C be cured?

Absolutely. Chronic hep C is now curable. This is awesome news.

New medications called DAATs (direct-acting antiviral therapies) can cure hepatitis C type 1 in most patients who have access to them. But, there is a catch: These drugs are expensive, and accessing them can be complicated.

What are the new hep C treatments?

The new treatments for hep C type 1 (DAATs or direct-acting antiviral therapies) include drugs like:

  • Harvoni
  • Epclusa
  • Mavyret

In the past, treatments for hepatitis C included interferon, a medication with many unpleasant risks and side effects. The cure rates were not that great either.

The new treatments (DAATs) are all “interferon-free”, so they have fewer side effects and risks than drugs containing interferon. Here are other benefits of Harvoni, Epclusa, and Mavyret:

  • Treatment courses are only 8-12 weeks long
  • Medication can be taken by mouth
  • Dosing requires only one tablet once a day
  • Cure rates are high (greater than 95%)

There are some other—equally effective—treatment options, but these need more complex testing upfront and you will probably need to take more than 1 tablet per day:

  • Zepatier *
  • Viekira *

*You may need to add Virazole (ribavarin) with these treatments, depending on the subtype of HCV type 1 infection you have and whether or not you have liver cirrhosis.

How can I be sure my hep C is cured?

12 weeks after your treatment has ended, a blood test can measure how much viral genetic material (viral RNA) is in your blood. If no viral RNA is detected, this is called a “sustained virologic response” (SVR, for short). An SVR is important because studies show us that 99% of all SVRs end in a long-term cure.

So, to be clear: New hep C treatments cure hep C type 1 more than 95% of the time, and a simple blood test 12 weeks after you finish treatment will confirm that this is the case.

I’ve had hep C treatment before, but it didn’t work. What now?

If you’ve had treatment for hep C before, and it didn’t work, don’t despair. The new treatments we talked about here still have great cure rates (>95%) even if older medications didn’t work for you. The choice of treatment will depend on what you’ve already tried, what other medications you currently take (if any), and—as always—cost and availability.

How much do the new hep C treatments cost?

The new hep C drugs are expensive. So expensive, that two of them make it onto our list of the 11 Most Expensive Drugs in the U.S.A. This is because they are still patented (although that is due to run out this year for Harvoni and Epclusa—but without any promise of significantly cheaper generics).

Luckily, hep C treatment is covered by most insurance plans, so for many people, the cheapest way of getting it will be through insurance (although you’ll probably need prior authorization).

If your hep C treatment is not covered by your insurance, ask your doctor about an appeal. The exact process will depend on your insurance provider but often requires that you work with your doctor to submit an appeal letter.

Other savings tips worth checking out:

Manufacturers’ $5 copay cards can make treatment more affordable (for commercially insured patients only):

  • Harvoni copay card
  • Epclusa copay card
  • Mavyret copay card

Patient assistance programs are available to help low-income, uninsured patients save on their hep C treatment:

  • Harvoni patient assistance program
  • Epclusa patient assistance program
  • Mavyret patient support program

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