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Could I Be Turned Down for Hepatitis C Treatment Because of Prior Drug or Alcohol Use? A Doctor Explains

August 28, 2015

The world of hepatitis C treatment is changing and access to the new, more effective hepatitis C drugs is a concern for both doctors and patients. There are a lot of questions as to why people are prescribed or not prescribed these drugs. To help answer some of the most pressing hepatitis C treatment questions, TheBody.com spoke to Maribel Rodriguez-Torres, M.D., a leader in hepatitis C research and treatment in Puerto Rico.

Will my insurance company tell me I am ineligible for hepatitis C (HCV) treatment because of prior drug or alcohol abuse?

Maribel Rodriguez-Torres, M.D.

Maribel Rodriguez-Torres, M.D.

Because HCV drugs are so expensive, when payers (insurance companies) learn that one of their covered patients has screened positive for HCV, they try to find ways to restrict coverage. It makes sense to prioritize sick patients over healthy patients. But there is also an idea that drug and alcohol users are more likely to get re-infected, so they shouldn't be allowed to receive drugs first. However, there is no scientific or evidence-based information to support the idea that this population has higher reinfection rates than non-users. The main purpose of this policy is to restrict access, and it is a huge concern.

Obviously, it is not a good idea to use drugs or alcohol if you have HCV. But there has not been any study to show any difference in outcomes between non-drug users and drug users. I think that if the patient who used drugs or alcohol is very sick, he should be treated. It might be possible to wait for a few months to put this patient through rehabilitation first, and then treat him. I would personally never refuse such a patient unless I thought he was truly unable to stay compliant with the drug regimen.

Maribel Rodriguez-Torres is the founder and president of Fundación de Investigación (FDI), the largest clinical research center in Latin America. She received both her M.D. and her postgraduate fellowship at the School of Medicine of the University of Puerto Rico. She dedicates much of her time today to working with the government to increase access to treatment for patients without health insurance.

Sony Salzman is a freelance journalist reporting on health care and medicine, who has won awards in both narrative writing and radio journalism. Follow Salzman on Twitter: @sonysalz.


Copyright © 2015 Remedy Health Media, LLC. All rights reserved.


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