Tens of thousands of Canadian patients with mild versions of chronic hepatitis C could soon receive public funding for medications that cure the infection now that the provinces have sealed a deal with three pharmaceutical companies to reduce the cost of the ultra-expensive drugs.
The pan-Canadian Pharmaceutical Alliance (pCPA), which negotiates prices on behalf of the provincial and territorial public drug programs, announced on Tuesday that it had reached an agreement with the makers of six breakthrough hepatitis C medications, including the best-known drugs in the class, Harvoni and Sovaldi.
Shortly after the pCPA confirmed the deal, the British Columbia government declared that its PharmaCare program would begin covering the drugs for patients with chronic hepatitis C, regardless of the type or severity, beginning in 2018.
That is an important change from B.C.'s current policy, which restricts public funding of the drugs to patients with certain genotypes of hepatitis C and advanced liver scarring.
"This is excellent news," said Julio Montaner, director of the British Columbia Centre for Excellence in HIV/AIDS, which has a hepatitis C research program.
"By having a more widely available treatment, you can foresee a situation where not only are [hepatitis C] morbidity and mortality controlled, but also we change the course of the epidemic," he said. "Ultimately, we can aim to control the hepatitis C epidemic in our midst."
Ontario confirmed Wednesday that it, too, will expand access to hepatitis C medications as a result of the agreement.
By the end of this month, the province will add four new hepatitis C therapies to the list of drugs it covers for qualifying patients. Like B.C., Ontario will extend coverage to all hepatitis C patients within the next 12 months, regardless of the severity of their liver disease.
In 2015-2016, Ontario spent as much as $290-million on new hepatitis C drugs for more than 3,700 patients, according to a spokesman for the Ministry of Health and Long-Term Care.
However, the real price the government paid for those medications is almost certainly lower because of undisclosed discounts.
It is too early to say how many other provinces will follow the lead of B.C. and Ontario, the two provinces that led the hepatitis C pricing negotiations on behalf of the pCPA. Whenever the pCPA concludes a deal for undisclosed price reductions, each province still has to decide how to implement the changes to its own public drug plan.
An estimated 250,000 people in Canada have hepatitis C, a virus that today is most commonly acquired through sharing dirty needles.
In the past – particularly before the virus was identified in 1989 – hepatitis C spread through tainted blood and contaminated medical equipment such as syringes.
Left untreated, the virus can lead to severe liver cirrhosis, liver cancer and death.
The new generation of direct-acting hepatitis C antivirals is a massive improvement over traditional treatments, experts say.
The old regimen of a weekly injection of interferon and daily tablets of ribavirin for six to 12 months was effective in fewer than half of all cases and had serious side effects, including fatigue, depression and irritability.
By contrast, the new drugs come with scant side effects, take three months or less to work, and are up to 95 per cent effective at clearing the hepatitis C virus – at which point it can no longer be transmitted.
"It's really quite revolutionary," said Morris Sherman, chairman of the Canadian Liver Foundation and a hepatologist at the University Health Network in Toronto.
The revolution had a colossal price tag: $45,000 to $100,000 per patient, depending on the case.
Public spending on prescription drugs across the country rose by 9.2 per cent in 2015; about two-thirds of that increase could be attributed to new hepatitis C drugs, according to the Canadian Institute for Health Information.
The pCPA never reveals the lower prices it negotiates with drug companies.
In this case, the alliance inked agreements with Gilead Sciences Canada, Merck Canada, and Bristol-Myers Squibb Canada, which together make six therapies for hepatitis C.
The new deal further reduces the price for Harvoni and Sovaldi, which had been the subject of a previous pricing arrangement, and adds to the pact four other drugs, Daklinza, Epclusa, Sunvepra and Zepatier.