A new generation of direct-acting antiviral medications taken orally are now available to Australians living with chronic hepatitis C. They are more effective, easier to take and have fewer side-effects than the older medications. The Australian Government has listed these medicines on the Pharmaceutical Benefits Scheme (PBS), ensuring they are accessible and affordable to people with hepatitis C. This is a leap forward in the management and treatment of hepatitis C and positions Australia as a world leader in publicly-funded access to these new, highly effective medicines.
What are the new medicines?
The new, direct-acting antiviral (DAA) medicines available on the PBS include:
- Epclusa® (sofosbuvir + velpatasvir)
- Harvoni® (sofosbuvir + ledipasvir)
- Zepatier® (grazoprevir + elbasvir)
- Maviret® (Glecaprevir + pibrentasvir)
Following a clinical assessment, these medicines are used independently or in combination with other medicines depending on the person’s particular situation. For most people, this will mean 8 to 12 weeks of taking tablets without the need to use Interferon.
Are the new medicines better than the previous ones?
Yes, the new DAA medicines are:
- more effective, resulting in a cure for 90-95% of people
- taken as tablets only, and have very few side-effects
- taken for as little as 8-12 weeks in most cases, and;
- provide interferon-free treatment options for all genotypes in Australia
Are the new medicines available for all people with Hepatitis C?
Yes, treatment using the new DAA medicines is available through the PBS for all people living with hepatitis C over the age of 18 and who have a Medicare Card. However, the particular combination of medicines used will depend on a range of factors which include genotype, prior treatment experience and whether or not you have developed fibrosis or cirrhosis (liver scarring).
What about people who currently inject drugs?
There are no restrictions applied to people who inject drugs – in fact they are a priority population for hepatitis C treatment. Whether or not a person currently injects drugs is not, and should not be used as criteria for restricting access to the new medicines.
Can people in prison access the new medicines?
Yes, people in prison are a priority population for hepatitis C treatment. The Australian Government has ensured the new medicines will be funded for people in prison. There may be some criteria depending on a prisoner’s length of stay as to whether they will be able to access the treatments whilst incarcerated.
Are there interferon-free options available for all genotypes?
Yes there are interferon-free options available for all genotypes.
What information will the doctor need to know about your health before treatment can be prescribed?
There are a number of tests the doctor may order, and s/he may also request specific information before treatment can be prescribed. These include:
- undergoing blood tests to confirm you have active hepatitis C infection, viral load and genotype (strain)
- undergoing an ultrasound to see if you have developed cirrhosis (liver scarring)
- discussing any previous treatments for hepatitis C under taken,
- identifying any other illnesses or health complaints a client may have such as Hepatitis B, HIV, Epilepsy or Diabetes and;
- discussing any other prescription medications, over-the-counter medications or substances a client may be taking. This is important to avoid any possible drug interactions with the DAA treatment.
It is very important that medicines are taken as instructed, so the doctor or nurse may also talk with you about your readiness to start treatment and discuss things that may impact on your ability to take the medicine regularly, as prescribed.
What does treatment with the new medicines involve?
The treatment regimens for the new DAA medicines range between 8 and 24 weeks for a complete course of treatment. The length of treatment depends on the genotype, treatment history, whether cirrhosis has occurred and the combination of medicines used.
Some treatments require only 1 to 2 tablets once or twice a day. For some treatment regimens, more medicines may be required to be used together. Depending on treatment history and genotype, a very small percentage of people may still need to include an injection (of peg-interferon) as well as taking tablets. Your doctor will explain the options available to you in more detail.
Will you need to have more tests during treatment?
Yes, the doctor will need to do blood tests to monitor how the body is responding to the medicines.
Can General Practitioners (GPs) prescribe treatment for hepatitis C?
Yes, GPs in Australia can prescribe the new medicines. Before prescribing any medicines, the GP will be required to collect information and conduct tests (see above) to establish which combination of medicines will be the most effective. This means it is likely you will need a couple of appointments before receiving a prescription. In some cases, where there are other significant health factors to consider, the GP may refer the client to a specialist before treatment.
Can you still see your specialist to access the new medicines?
Yes, gastroenterologists, hepatologists or infectious diseases physicians experienced in the treatment of chronic hepatitis C will continue to prescribe the new medicines. These specialists will also provide advice to GPs prescribing the new medicines, so you may consider seeing your GP if this is more convenient for you.
Where can you get your prescription filled?
The prescription can usually be filled by a local pharmacy.
It is important to note that some pharmacies may not have the medicines in stock and people may need to wait up to 72hrs to collect them. This is due to the very high cost the pharmacies have to outlay to keep the medicines in stock.
If a pharmacy cannot fill the prescription, request a referral to a pharmacy that can, or contact HepatitisWA for assistance.
Most pharmacies will only dispense 1 month of the drug at a time. Therefore, it is important for you to plan ahead so they don’t run out of medicine. Leaving your repeat scripts with your pharmacist can be helpful.
How much do the medicines cost?
Prescriptions attract the usual co-payment price for the dispensing fee of each prescription. This is currently $38.80 for general patients and $6.30 for concessional patients. This fee is reviewed each year.
What if treatment is not effective?
For most people, it is highly likely the new DAA medicine will be effective. If the new treatment does not work, the doctor will discuss options and may choose to refer to a specialist for further assessment prior to commencing any further treatment.
Where can you get further information?
You can talk to your GP, specialist, clinic nurse or call HepatitisWA on (08) 9227 9800.
Don’t put your health at risk by waiting too long.
It’s easy to understand why people may have waited for the new interferon-free treatments to become available. However, now treatment is much simpler, by waiting, a person could be putting their health at risk. If 40 years of age or over is living with hepatitis C, they are likely to experience an accelerated rate of liver damage which increases the risk of developing cirrhosis, liver cancer or liver failure. This is called the “Liver Danger Zone”. A person should also bear in mind that symptoms of liver disease may not be felt until the liver is significantly scarred. It is not advisable for people to put their health at risk by waiting too long for treatment. It is recommended to make an appointment with a doctor or HepatitisWAs Deen Clinic to have a liver health assessment and to discuss treatment options.
What does a liver health assessment involve?
The doctor will conduct a clinical examination and blood tests. They may also send the client for an ultrasound which is a non-invasive test that measures the level of liver scarring to determine the severity of liver disease. For further information on the liver health assessments see our: Liver Assessment Factsheet – Download Now (PDF)
Video of a liver health assessment – view now If a person has chronic hepatitis C and particularly if they are in the “Liver Danger Zone”, ask the doctor about having a regular liver health check-up today. A liver check-up is nothing to worry about, it is simple, easy and it can save lives.