Technically speaking Hepatitis C treatment in Italy with DAAs (Epclusa, Zepatier and Viekirax) is available free under the national health service. Unfortunately, the reality of Hep C treatment in Italy is very different.
Unlike most countries with a National Health Service the Italians have not triaged access to Hep C treatment based on Liver Fibrosis levels. Again, technically this means that all Italians with Hepatitis C can get free treatment from the Italian national health service. Whilst this sounds great for Italians needing Hepatitis C treatment the reality of access to treatment is very different… long waiting lists exist across Italy for access to Hep C treatment. Italians waiting for Hepatitis C treatment are being told there is no medication to treat them with and no money to buy more medication.
In Italy health is a regional responsibility and regional hospitals get funding from the central government. So not all doctors or hospitals in Italy can prescribe Hep C treatment in Italy, such as Epclusa, only doctors and hospitals authorised by the Italian government can do this.
This creates a situation where there are long waiting times for access to doctors and hospitals authorised to prescribe Hepatitis C treatment in Italy. This then creates a situation where people may offer bribes to hospital officials to be moved up the waiting list or face the very real prospect of not getting treatment before their liver disease progresses to an incurable stage.
But at least Hep C treatment is available in Italy … or is it? In the last few months more and more Italians with Hepatitis C have been told that, yes, they are entitled to free treatment, but, no, they cannot get treatment because there is no medicine available.
So what is really happening in Italy?
Since generic Hep C medicines became available from India the Italian government actively and vigorously blocked access to these generic Hep C treatments. Not only that but the Italian (so-called) Hep C advocacy group EPAC actively campaigned against generics whilst aggressively lobbying the Italian government to buy DAAs from Big Pharma. The most likely, and obvious, reason for EPAC taking an anti-generic treatment position is because EPAC receives a huge amount of funding every year from Big Pharma companies, the same companies that wanted to supply the Italian health service with Hep C medication.
However, despite the efforts of EPAC, and the Italian government, Italians began curing their Hepatitis C with generic Hep C meds. Working as a group we Hep C “pirates” figured lots of ways of helping Italians to do this. For example, Italians could fly to Malta or the UK and quite legally have generic medicines sent to them there. We also found a loop hole in Italian law that allowed Italians to import Darvoni (Sofosbuvir + Daclatasvir in one pill) directly into Italy. So, generic Hepatitis C treatment was flowing into Italy and Italians were getting cured.
So how did Big Pharma and its Italian servants deal with this?
With the surging supply of generic Hepatitis C treatments into Italy Big Pharma saw a situation rising where Italy might follow Britain, Romania, Latvia and other enlightened nations and allow easy importation of generic Hep C treatment.
So, in negotiations Italy got a very good deal (relative to what other countries are paying) with a price of around US$10,000 for a 12 week treatment using DAAs such as Epclusa, Zepatier and Viekirax.
(I should add here that the price being paid for Epclusa in Italy should be very upsetting to citizens of the USA who are paying 8 times that amount for Epclusa, a drug that was developed with US taxpayer’s dollars)
In Italy there are at least one million people infected with Hepatitis C, about 100,000 have been treated since 2015, or about 10% of the infected population.
For Italy to treat the remaining 900,000+ people infected with Hep C would cost at least $9,000,000,000.
And remember that is just the cost of the medicine and does not include the cost of testing and monitoring etc, which would add at least another 20% to the figures above.
These treatment figures are called Budget Busters!
These amounts of money are impossible to find in a health service that is already hard pressed to find money for other health issues… it is way too much money… impossible money!
So, we come back to the question why do governments keep blocking access to generic Hepatitis C treatment? Importantly why does the Italian Hep C advocacy group EPAC keep advocating for Big Pharma rather than advocating for Italians with Hepatitis C?
Let us be honest; if EPAC was working for the best outcomes for Italians with Hepatitis C then it would be lobbying the Italian government to make access to generic Hep C medication easier. This would remove pressure from the Italian health services and make treatment more accessible to all Italians seeking Hepatitis C treatment in Italy.
Italians who could afford generics could pay for their own treatment and those would could not afford generic DAAs could get them through the Italian national health service for free.
Those Italians with Hepatitis C who were happy to wait for treatment through the Italian national health service could wait and those Italians who did not want to wait could be treated at no cost to the Italian government and health service.
It is a simple, logical solution where everyone is a winner. So why does EPAC not advocate this path? Simply because they are servants of Big Pharma and not of Italians with Hepatitis C.
All around the world this is the problem. Big Pharma funds Hepatitis advocacy groups like EPAC and the World Hepatitis Alliance and these advocacy groups lobby governments to spend their health budgets on Big Pharma’s mega expensive Hep C medications. They do no work for the best outcome for people with Hep C, they work for the best outcome for their pay-masters; for Big Pharma!
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