Access to Hepatitis C Treatment
From March 1, 2016, the new generation of direct-acting antiviral medications became available to all Australians living with hepatitis C. These medicines are more effective, easier to take and have fewer side-effects than previous medications. The Australian Government has listed these new medicines on the Pharmaceutical Benefits Scheme (PBS). This has ensured they are accessible and affordable to all people with hepatitis C. This forward thinking has made Australia a world leader in the management and treatment of hepatitis C. In the first four months of the new medicines being available on the PBS, 26,000 people accessed new hepatitis C treatment.
What are the new medicines?
The new, direct-acting antiviral (DAA) medicines that are now available on the PBS include:
- Daklinza® (daclatasvir)
- Harvoni® (sofosbuvir + ledipasvir)
- Ibavyr® (ribavirin)
- Sovaldi® (sofosbuvir)
- Viekira Pak® (paritaprevir + ritonavir + ombitasvir + dasabuvir)
- Viekira Pak RBV® (paritaprevir + ritonavir + ombitasvir + dasabuvir + ribavirin)
Once you have a medical assessment, these medicines will be prescribed either independently or in combination with other medicines depending on your particular situation. For most people, this means hepatitis C treatment without the need to use interferon.
Since the new treatments became available, NUAA has been receiving a lot of phone calls from our members wanting to know more. Here we try to answer some frequently asked questions. If you have any other questions, please contact NUAA on (02) 8354 7300 or 1800 644 413, or contact us through our online form – click here.
Frequently Asked Questions
Are the new DAA’s available for everyone with Hepatitis C?
Yes, the new DAA medicines are available through the PBS for anyone living with hepatitis C over the age of 18 and who has a Medicare card. Even if you are homeless, if you have a Medicare card you can access treatment. Many drug and alcohol services and some chemists will hold your meds and dose them to you weekly or even daily if you are worried about losing them. What combination of medicines you will be prescribed will depend on a range of factors, including your genotype, prior treatment experience and whether or not you have developed cirrhosis (liver scarring).
Is it true that my GP can prescribe treatment for hepatitis C now?
Yes, any GP or prescriber in Australia can prescribe the new medicines. But before your GP or prescriber can prescribe the new DAA’s, your GP or prescriber will need to collect information and organise the preliminary blood tests to establish which combination of DAA’s will be the most effective for you. Based on your test results, your GP or prescriber will need to consult with a liver specialist before prescribing treatment for you. This means it is likely you will need a couple of appointments before you start treatment. In some cases, if there are other significant health factors to consider, your GP or prescriber may refer you to a liver specialist before treatment can be started.
If you don’t have a GP, you can call the Hepatitis Line on 1800 803 990. They can assist you in finding a GP or clinic in your area that is providing hepatitis C treatment. Or you can go online and check out their directory.
Can I still see a liver specialist to access the new medicines?
Yes, gastroenterologists, hepatologists or infectious diseases physicians experienced in the treatment of chronic hepatitis C will still continue to treat patients with hepatitis C. These specialists will also provide advice and assistance to GPs or prescribers who are new to treating hepatitis C and prescribing the new medicines.
What if I am still using?
There are no restrictions applied to people who currently inject illicit drugs. Current injectors are seen as a priority population for hepatitis C treatment. If you have difficulty accessing treatment or feel you have been discriminated because of your current drug use, please contact NUAA.
I might be going to jail soon. Can I still access the new DAAs?
Yes, people in prison are a priority population for hepatitis C treatment. The Australian Government has ensured that the new medicines will be funded for people in prison. If you are in jail, make an appointment to see the Justice Health nurse and let them know you would like to start hep C treatment.
What is the process for getting onto treatment?
Before your doctor starts you on hep C treatment, you will need to do a number of tests. These include:
- Blood test (Anti-Body Test) to confirm you have been exposed to the hepatitis C infection. The antibody test can’t tell you if you still have hep C, just that you have been exposed to it.
- Blood test (PCR test) will be able to tell if you have hep C, tells you what genotype (strain) you have, and it also measures the viral load,( how much virus is in your blood).
- Undergoing an assessment (FibroScan) to see if you have developed cirrhosis.
- Identifying any other illnesses or health complaints you might have.
- The doctor will want to know if you have been on any previous treatments for hepatitis C if there were or weren’t successful.
- Discussing any other prescription medications, over-the-counter medications or substances you are taking. It is important, to be honest, to avoid any possible drug interactions.
What is a FibroScan?
FibroScan has replaced liver biopsy. It is a non-invasive device that lets doctors and nurses measure the ‘hardness’ (or stiffness) of the liver using transient elastography. Basically it is like an ultrasound for the liver. It is painless and takes around 5 minutes to perform. You will be asked to lie on the examination table, the doctor or nurse will apply a water based gel to your side, then the FibroScan will be passed over the skin and you will receive the results on the health of your liver in 5 minutes.
What is cirrhosis (liver scarring)?
When damage occurs to the liver over time, be it through viral infection or drinking, the inflammation becomes permanent scaring know as cirrhosis. Cirrhosis means the liver is unable to heal itself. You can still live a long life if cirrhosis is diagnosed early and you treat the underlying cause (hepatitis C) and stop the progression of cirrhosis through treatment.
What does the new treatment involve?
Treatment with the new DAA medicines can last between 8 and 24 weeks for a complete course of treatment. The length of your treatment will depend on your genotype, treatment history, whether you have cirrhosis and the combination of medicines recommended. Most new treatments require you to take only 1 to 2 tablets once or twice a day. For some treatment regimens, you may be prescribed more medicines to be used together depending on your genotype and your previous treatment history. Your treatment may include an injection (of peg-interferon) as well as taking the new DAA tablets. Your doctor will explain the options available to you in more detail once you have completed all preliminary tests.
Is the new treatment interferon-free?
Currently, interferon-free treatment options are only available for genotypes 1, 2 and 3 – but these are the most common genotypes in Australia. For now, treatment for people with genotypes 4, 5 and 6 will still require taking a combination of one of the new medicines in conjunction with pegylated interferon and ribavirin, but for a shorter period of time. New DAA medicines are still in development and are likely to be considered by the Government for listing on the PBS. Also, as new data becomes available, the use of current medicines may be broadened to include other genotypes. For more information about new treatment check out the Hepatitis Australia website.
I’m still worried about side effects.
There are still side effects with the new DAA’s, but nothing as debilitating as the side effects that many experienced with interferon-based treatments. The feedback NUAA has received from people who have been on the new DAA’s is that side effects are minor and easily tolerated. You might experience some nausea, sleeplessness, tiredness and/or some cramping, but most of these side effects don’t last more than a few weeks.
I suffer from depression and I worry I might get even more depressed.
Unfortunately this was such a common problem with the old treatments that doctors often jointly prescribed anti-depressants with hepatitis C treatment. However, of all the side effects that have been reported to NUAA no one has reported depression. Depression is a common symptom of hepatitis C, so treating hepatitis C may actually help you overcome your depression. If you are concerned, it is a good idea to speak to your Doctor about treatment options for depression before going to hep C treatment.
What tests will I need to do during treatment; I am worried my veins can’t take the blood tests?
There are a lots of ways you can help your veins to make having bloods taken easier. Plan your blood tests so you can use water, heat and exercise to make your veins easier to find. User’s News Issue 83 has tips on helping your phlebotomist. During the course of your treatment, you will be required to undergo blood tests to monitor how your body is responding to the new medications. These blood tests are important as they will be monitoring how effective the DAAs are against the hepatitis C virus in your system and to ensure the new DAAs are not negatively affecting your overall health. Then, 12 weeks after treatment has been completed, you will need to do another PCR viral load test. If the PCR viral load test shows no virus at 12 weeks after treatment then you are considered cured of hep C.
Where can I get my prescription filled?
This will depend on the type of prescription you receive from your GP or prescriber. There are two types of prescriptions an s100 or s85. You will most likely receive an S85 prescription, which can usually be filled by your local chemist. However, it is important to remember that due to the high cost of these DAAs, many chemists don’t keep these medicines in stock. Most chemists will need to order them in for you, which can take between 24 to 72 hours. If the local chemist won’t order these drugs in, ask them for a referral to a chemist that will. Hep NSW has compiled a list of chemists that carry the new DAA’s you can ring them on 1800 803 990 or look online.
You are more likely to receive an S100 prescription if you are receiving treatment through a Liver Clinic or Hospital. An S100 prescription can only be filled through a hospital-based pharmacy and not by your local chemist. Some hospital based pharmacies only allow you to collect 4 weeks’ supply of medicine at a time. So it is important to be organised and to plan ahead so you don’t run out of medicine.
How much will the medicines cost me?
Hep C treatments are listed on the Medicare PBS (Pharmaceutical Benefits Scheme), which makes them almost free. (The cost is reviewed by Government each year, so check the Hepatitis NSW website for up-to-date information.) If your treatment requires a combination of more than one of these new DAAs you may find you need to pay the dispensing fee for each medicine.
I have Genotype1, what if treatment is not effective for me?
The new DAAs treat all genotypes, with a cure rate of 95-97 per cent for all genotypes 1, 2, and 3, compared to previous treatment regimes which had only 50 per cent cure rate. Not only do the new DAAs have a higher cure rate, treatment time is also reduced to 12 weeks, rather than 12 months, with very few side effects. If the new treatment does not work for you, your doctor will refer you to a liver specialist for further assessment prior to you commencing any further treatment.
Going onto treatment just seems too hard.
Getting onto to the new treatments isn’t really that hard. It’s not like the old days when all you had to look forward to was months of depression and exhaustion. If you are still unsure, you can ring NUAA on 1800 644 413 or (02) 8354 7300 and speak to a NUAA Peer Support worker about any questions you still have about treatment. You can also ring the Hep NSW, Hepatitis Info Line and speak to a hep C peer on 1800 803 990 for advice on how to make treatment easier for you.
Where can you get further information?
- You can talk to your GP or prescriber, liver specialist, clinic nurse.
- You can call the National Hepatitis Information line on 1800 437 222.
- You can call HepNSW Hepatitis Info Line 1800 803 990.
- You can call NUAA on 3854 7300 or 1800 644 413.