“Hepatitis C is a devastating disease. Unfortunately, the majority of people with Hep C do not even know they are infected. Family physicians, primary care, and other physicians and care team members have a critical role to play to identify these people and save their lives.” – Ron Chapman, MD, MPH, family physician and Past Director/State Health Officer, California Department of Public Health
CAFP is actively involved in the push for more engagement of family physicians and primary care physicians in the screening, diagnosis, treatment, and management of patients with hepatitis C. According to the United States Preventive Health Task Force guidelines, all baby boomers (those born between 1945-1965) should be screened for Hepatitis C.
Screening + Testing
Hepatitis C is a serious liver disease that results from infection with the Hepatitis C virus. Hepatitis C has been called a silent disease because people can get infected and not know it. Some people who get infected with Hepatitis C are able to clear, or get rid of, the virus but most people who get infected develop a chronic, or lifelong, infection. Over time, chronic Hepatitis C can cause serious health problems including liver damage, liver failure, and even liver cancer. For more information on the CDC and USPSTF guidelines on testing, visit this webpage.
Providing all hepatitis C patients with access to a cure is the most effective way to eliminate the virus at a population level. Currently, injection drug use is the primary mode of hepatitis C transmission in the U.S. The Department of Health and Human Services (HHS) has identified an “emerging epidemic of hepatitis C infection among young persons who inject drugs.” Providing treatment to active injection drug users is crucial to reducing the hepatitis C burden within injector networks and preventing new transmissions. Further, curing hepatitis C is the best way to ensure that health care providers are not exposed to the virus, and guarantee that women of childbearing potential do not transmit the virus to their developing fetus if they become pregnant.
A good summary on the cost-effectiveness of the treatment regimens provided is in the HCV guidelines. Most experts conclude that today’s regimens are cost-effective (depending on how you measure – $/QALY, etc.); the problem is high demand which could strain budgets up front, which is part of the justification for the Metavir rationing strategies employed by many states and insurance companies.
Coding + Billing
The California Department of Health compiled this screening toolkit for providers regarding hepatitis B and C. It includes billing codes for viral hepatitis.
CMS will cover screening for HCV with the appropriate U.S. Food and Drug Administration (FDA) approved/cleared laboratory tests, when ordered by the beneficiary's primary care physician or practitioner within the context of a primary care setting. A screening test is covered for adults at high-risk for Hepatitis C Virus infection. A single screening test is also covered for adults who do not meet the high-risk as defined above, but who were born from 1945 through 1965.
Drug Assistance Program
Several pharmaceutical companies have drug assistance programs for patients with financial needs.
Hepatitis C Online is a free, educational web site from the University of Washington. The site is a comprehensive resource that addresses the diagnosis, monitoring, and management of hepatitis C virus infection.
Project ECHO is a teleconferencing system led by teams of experts, who educate primary care
doctors, nurses, and other clinicians in specialty care in their communities.
Family doctors prescribing for CalPERS members may wish to refer to utilization management criteria and resources on the pharmacy benefits manager OptumRX's website. These include access to a formulary and prior authorization forms.
Data + Research
These two publications produced by Project Inform will be useful to you as you begin treating patients with Hep C.