Legislature Lunch&Learn

 

On Monday March 6th, Liver Health Connection, member of the Chronic Care Collaborative hosted a lunch&learn to discuss,”How to Prevent Liver Cancer in Four Easy Steps.” Activities included free box lunch for all attendees and free HCV antibody testing.

 

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Robert McGoey and Karen Chappelow set up for the HCV antibody testing.

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Nancy Steinfurth, Robert McGoey and Nicole Silva at the Colorado State Capitol.

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Executive Director of Liver Health Connection, Nancy Steinfurth.

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Nancy speaking about ways to safeguard your health from liver damage to legislative aides.

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Colorado VA’s Rural Hepatitis Telemedicine Program

The Veterans Administration (VA) has initiated an ambitious program to provide hepatitis C (HCV) treatment to all veterans with the virus.  The VA is treating all veterans with HCV regardless of fibrosis score or other criteria.

Becky Ashcraft, Nurse Coordinator for the Colorado VA’s Rural Hepatitis Telemedicine Program, recently presented some of the progress that they’ve been making to ensure that Colorado veterans who live in rural areas can receive treatment for hepatitis C.

We’d like to share just a little bit from her presentation highlighting the work that they Program are doing. The Rural Hepatitis Telemedicine Program is working to bring HCV treatment to rural areas of Colorado by using technology to help patients receive specialist care in rural areas.

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This slide shows the uptick in patients being treated by the programs during 2016.  Increased VA funding for HCV treatment has led to a substantial increase in the number of veterans being treated.

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Patient compliance with the treatment regimen – which usually involves taking a pill once a day for 12 weeks – has been around 95%.  Patients receive medication through the mail and have appointments at one of several clinics throughout the state.

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Sustained Virological Response (SVR) means that a there is no detection of HCV in a patient 12 weeks after completing treatment.  SVR is how we know someone has been cured of HCV.  The Rural Hepatitis Telemedicine Program helped 73 patients achieve SVR in 2016.  For only a handful of patients, treatment was unsuccessful.

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This final slide show why it’s so important that more veterans are being treated.  Veterans have higher rates of HCV than the general population, especially veterans who are baby boomers.  The data above shows reductions in mortality and liver cancer for veterans who have been cured of HCV compared to veterans who still have the virus.  Because Direct-Acting Antiviral (DAAs) treaments for HCV are still so new, the data above is of patients who underwent successful treatment using interferon-based therapy – a treatment that was less effective and had far more complications than new DAAs.  As  more veterans get treated, we can anticipate even greater reductions in the number of liver transplants, rates of liver cancer and overall mortality.

2017 Chronic Disease Legislator Lunch&Learn

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You’re invited!

“How to Prevent Liver Cancer in Four Easy Steps”

The 2017 Chronic Disease Legislator Lunch & Learn on Monday, March 6th!

Please join Liver Health Connection, a member of the Chronic Care Collaborative, for a free box lunch on Monday, March 6th at the Colorado State Capitol to discuss ways to safeguard your health from liver cancer.

Liver cancer is on the rise – 72% in a decade. Undiagnosed hepatitis C is the primary reason for this increase in liver cancer. Free HCV antibody testing will be provided with results in 20 minutes to baby boomers (born between 1945 and 1965.)

Activities take place at the Colorado State Capitol in House Committee Rooms 109 and 111.  We will begin at noon until 1:15pm.

We hope to see you there!

 

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Denver State Capital

Viral Hepatitis in Colorado

viral-hep-in-co-2015-surveil-reportThe Colorado Department of Public Health and the Environment (CDPHE) recently released Viral Hepatitis in Colorado: 2015 Surveillance Report, CDPHE’s annual report on the impact of hepatitis A, hepatitis B and hepatitis C on Colorado’s communities.

The report is full of important information and statistics about new cases of viral hepatitis, who’s most impacted and what steps could be taken to eliminate viral hepatitis.  Here are a few key findings:

  • There are an estimated 70,935 Coloradans currently infected with HCV.
  • There are an estimated 16,370 Coloradans currently infected with HBV.
  • Most Colorado children (92.1% in 2015) receive all three doses of HBV vaccine by age 3, ye only 76.4% of newborns received the first dose of vaccine within the first three days of birth as recommended.
  • Mortality due to hepatitis C is increasing in Colorado, particularly among people born between 1945 and 1965.

Eliminating hepatitis B and hepatitis C is feasible if key barriers are addressed.  These include strengthening surveillance, expanding diagnosis, including prison inmates, and improving access to direct-acting antiviral drugs for hepatitis C.

Read the full report (and past reports) at the CDPHE Viral Hepatitis Data Page.

CO prisons allow preventable killer to lurk in the cells

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An important article in today’s Westword brings light to the status of Colorado prisons and their approach to hepatitis C prevention and treatment. This is a MUST read. #hepatitis #hepC #NoHep

Hep C: The Deadliest Killer in Colorado’s Prisons Is a Curable Virus
BY ALAN PRENDERGAST | TUESDAY, DECEMBER 13, 2016 AT 6:50 A.M.

When Joseph Deaguero went to prison almost three years ago, he had a pretty good idea of what to expect. He had been behind bars before, for a series of assaults and domestic-violence arrests. But this time around, Deaguero, who’s currently 52 years old and serving a twelve-year sentence for second-degree assault, began to wonder if he was going to survive the experience.

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In 1996, Deaguero learned that he’d tested positive for hepatitis C, a blood-borne virus that attacks the liver and has infected 17 percent of the American prison population. At the time he was told not to worry about it; the virus can lie dormant in the system for decades without manifesting any symptoms, and about one in six of those infected will “clear” the virus on their own. In other cases, though, the virus leads to chronic liver disease, and a sizable number of the chronic cases — between 25 and 40 percent, depending on which studies you believe — can eventually develop into cirrhosis or liver cancer.

Shortly after he started serving his latest sentence, Deaguero complained of symptoms of a hep C flare-up: chronic fatigue, aching muscles and joints, a constant throbbing pain in his lower back. He went to the prison infirmary for tests and was told that there were new wonder drugs coming on the market that could actually cure hep C, in more than 95 percent of the cases treated. But before he could qualify for the medication, the Colorado Department of Corrections required that he take alcohol- and drug-education programs that can last from six months to a year.

Deaguero took the programs. Last spring he contacted the prison medical providers again to ask when he could start taking the cure. He was told he didn’t qualify for treatment. The new drugs are obscenely expensive — at full retail value, as much as $1,100 a pill, or $95,000 for one patient’s daily dosages over twelve weeks. According to DOC standards, Deaguero’s liver wasn’t damaged enough yet to justify the expense. Medical staff would continue to monitor him, and if tests indicated that his condition had worsened to a sufficient degree, he would then become eligible for treatment.

Deaguero filed a grievance, arguing that it would be better to treat him now rather than risk further damage and possibly the $500,000 cost of a liver transplant down the road. “To invest in my treatment now would make a lot of sense at this point in my life,” he wrote. “Not when it’s too late.”

His grievance was denied. He is now appealing. “They provide the least treatment possible, and it takes forever to be seen,” he says. “I understand it’s expensive. So is treating cancer, but the DOC does it. They are not consistent on how they grant treatment.”

Complaints about the prison system’s severely rationed approach to treating hep C aren’t confined to Deaguero. Many of the 2,200 inmates in DOC who’ve been diagnosed with hep C worry about not only worsening aches and inflamed livers, but also their one-in-five odds of a protracted, agonizing death from cirrhosis and organ failure. “I am aware of four others just in my living unit that have hep C and are in the same situation as me,” says 61-year-old John Spring, who was diagnosed with the virus in 2005 and has been approved for monitoring but not treatment. “I know of three inmates who have died because the DOC did not treat them or delayed their treatment.”

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Preliminary Findings in Project to Grade Medicaid Access to Hepatitis C Treatment

FOR IMMEDIATE RELEASE
Contact: Caryn Benisch, 202-429-4940, carynbenisch@rational360.com

Harvard Law School & National Viral Hepatitis Roundtable Announce Preliminary Findings in Project to Grade Medicaid Access to Hepatitis C Treatment
Analysis from ‘Hepatitis C: The State of Medicaid Access’ Reveals Some Improvement, But Discrimination Persists in Many States; Medicaid Directors Put on Notice to Confirm Restrictions & Any Plans to Comply with CMS Guidance

SAN FRANCISCO, CA & BOSTON, MA (Nov. 14, 2016) – The National Viral Hepatitis Roundtable (NVHR) and the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) today announced the preliminary findings of Hepatitis C: The State of Medicaid Access – a comprehensive assessment of state Medicaid programs’ discriminatory restrictions on curative treatments for hepatitis C, the nation’s deadliest blood-borne disease. The full report, with accompanying rankings and state-by-state report cards, will be released in early 2017.

Preliminary analysis from Hepatitis C: The State of Medicaid Access – announced today at The Liver Meeting® in Boston – shows some improvements in both state Medicaid program transparency and access since 2014, yet also demonstrates that most states continue to impose discriminatory restrictions which contradict guidance from the Centers for Medicare & Medicaid Services (CMS), as well as guidance from AASLD and the Infectious Disease Society of America.  Also concerning is that nearly half of states may not be making all restrictions publicly available. To read the preliminary findings in full, visit http://www.chlpi.org/stateofhepc. (NOTE: Colorado data is not up-to-date.

This report does not reflect Oct. 1 prior authorization criteria.)

The Hepatitis C: The State of Medicaid Access final report will grade and rank each state, as well as the District of Columbia, according to overall “state of access,” as determined by curative treatment restrictions related to three areas: 1) liver disease progression (fibrosis) requirements, 2) sobriety requirements, and 3) provider limitations. The report will also provide the first-ever national assessment of Medicaid Managed Care Organization (MCO) coverage of curative HCV treatments.

“With this announcement, we are officially putting state Medicaid programs on notice,” said Ryan Clary, executive director of NVHR. “State Medicaid directors need to make all treatment criteria publicly available and detail any plans to comply with CMS guidance, which clearly states that coverage policies cannot block hepatitis C patients’ access to effective, clinically appropriate and medically necessary treatments. It is unacceptable to have discriminatory restrictions that conflict with the CMS guidance or with established hepatitis C treatment standards. Our final report will grade and rank each state’s access criteria, and states that continue to discriminate will be called out.”

Robert Greenwald, clinical professor of Law at Harvard Law School and the faculty director of CHLPI, commented, “There is some good news and some bad news here.  In comparing our current findings to a 2014  hepatitis C treatment access report I published with a team of researchers in the Annals of Internal Medicine, we find that many states have reduced discriminatory practices.  Disappointingly, we also find that restrictions persist in many states, despite our hope that with established treatment guidelines, clear guidance from CMS, and successful litigation, we would see far more progress in eliminating discriminatory hepatitis C treatment restrictions.”
Greenwald continued, “While I think there is a general consensus emerging that discriminatory hepatitis C treatment restrictions will eventually be removed, voluntarily or by courts, we must hold state Medicaid programs accountable now, as some states still see a budgetary incentive in dragging their feet as long as possible.”

Key preliminary findings of the Hepatitis C: The State of Medicaid Access project include:
•      Transparency surrounding state Medicaid program hepatitis C treatment access restrictions has increased overall since 2014;
•      Access to hepatitis C treatment has improved since 2014 – primarily in the reduction/elimination of liver disease or fibrosis restrictions, while access restrictions related to sobriety and prescriber limitations have decreased to a far lesser extent; and
•      While there are some MCOs with low levels of restrictions, many follow their states’ fee-for-service (FFS) Medicaid restrictions, while others impose more onerous restrictions in violation of federal law.

NVHR and CHLPI are asking state Medicaid directors to confirm all current treatment restrictions for curative hepatitis C treatments, and to detail any plans to broaden access and comply with CMS guidance. Medicaid officials may contact Ryan Clary (rclary@nvhr.org) and Robert Greenwald (rgreenwa@law.harvard.edu).

States for which fibrosis, sobriety, and/or provider requirements remain unknown include: Alabama, Alaska, Arkansas, California, Delaware, Georgia, Indiana, Kentucky, Maine, Michigan, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, South Carolina, Tennessee Utah, Washington, and Wyoming.

According to the Centers for Disease Control and Prevention, hepatitis C affects approximately 3.5 million Americans. For the past several decades, hepatitis C treatment regimens revolved around painful interferon injections, which are vastly ineffective at managing the disease on an individual level and the epidemic on a public health level. In contrast, the new generation of treatments offer cure rates of near 100 percent with minimal side effects, providing hepatitis C patients with an unprecedented chance to live virus-free – and avoid liver failure, cancer-causing cirrhosis, liver transplants, and other health complications.

About the National Viral Hepatitis Roundtable (NVHR)
The National Viral Hepatitis Roundtable is a broad coalition working to fight, and ultimately end, the hepatitis B and hepatitis C epidemics. We seek an aggressive response from policymakers, public health officials, medical and health care providers, the media, and the general public through our advocacy, education, and technical assistance. NVHR believes an end to the hepatitis B and C epidemics is within our reach and can be achieved through addressing stigma and health disparities, removing barriers to prevention, care and treatment, and ensuring respect and compassion for all affected communities. For more information, visit www.nvhr.org.

About the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI)
The Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) advocates for legal, regulatory, and policy reforms to improve the health of underserved populations, with a focus on the needs of low-income people living with chronic illnesses. CHLPI works to expand access to high-quality healthcare; to reduce health disparities; and to promote more equitable and effective healthcare systems. CHLPI is a clinical teaching program of Harvard Law School and mentors students to become skilled, innovative, and thoughtful practitioners as well as leaders in health and public health law and policy. For more information, visit http://www.chlpi.org.

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