I have a friend who just hit his 55th birthday; we’ll call him Lon.
Lon, a single father of a 15-year-old daughter, met a woman online and they began dating quite steadily. The two had reached the state where sexual relations were being considered and Lon’s girlfriend asked him to take the usual menu of sexually transmitted disease (STD) tests, to assure he was infection free.
So, Lon went to an STD clinic, where the nurse asked him the usual questions and he completed the form that was needed before the tests were administered. But then, Lon – who had seen the continuous television commercials geared toward baby boomers, saying they should be tested for hepatitis C – asked whether he needed to be tested for the STD, since it was not on the list.
The nurse practitioner asked Lon whether he had ever used intravenous drugs. Lon was no angel when he was in his teens and answered that he had indeed used needles some 40 years before.
So, the test was added to the list and the results were not what he had hoped for: He had signs of hepatitis C. So, the nurse sent Lon to his doctor to get a referral to a specialist to begin treatment of the progressive – and communicable – disease.
Aside from not understanding how he could have a disease from poor decisions made nearly 40 years before, Lon was scared, very scared.
Lon had just been laid off from a job he held for 27 years and since he could not afford paid health insurance, he was on Medicaid.
The specialist put Lon through a series of tests and sent the results to the managed care association (MCO) that was connected to his Medicaid. After weeks of waiting, the results came back: The MCO would not pay for the requested drug, Harvoni, but recommended that the specialist request a second, less expensive drug called Zepatier.
Both drugs are extremely expensive, with Harvoni treatment reaching the six-figure mark.
Again, Lon went through a series of somewhat uncomfortable tests to determine if he had any liver damage, which would determine whether the specialist would be authorized to prescribe the requested drug.
Again, weeks went by and the results came in: Although the tests showed Lon had some liver scarring, he was not sick enough to be prescribed the drug.
The specialist was surprised, but no one was more surprised than Lon: He had to be sicker before he could be treated for the ailment.
The absurdity was not lost on him, nor on his specialist, who told Lon to come back in six to 12 months to see if his liver was sufficiently scarred to be treated.
The shock was overwhelming: Lon called Medicaid, the MCO and went as far as to call state authorities to get the answer to several troubling questions:
How is it you want me to get sicker with a progressive disease in order to be treated and wouldn’t it end up being more expensive if you have to treat me then? Do I have to be near death to be treated for this condition?
Let me say after doing significant research, Lon learned that both drugs are extremely expensive, even if the requests had been approved.
But then Lon got what he considered the most shocking part of the whole ordeal: The state nurse told him that even if he had private or company insurance he would still be denied, because – by state standards – he wasn’t sick enough.
At least she was honest, but that didn’t make Lon feel any better. The nurse said the ailment is fairly common and he shouldn’t be too concerned, because since hepatitis C is only transferred through blood, as long as he didn’t do anything else to damage his liver he should be alright.
But, wait a minute, if he can’t be treated until he gets worse, can he have this condition until his dying day?
The nurse had no answer.
So Lon, who has since gone back to work, has to wait. And, when Lon and his girlfriend have relations, he has to take precautions.
So, next time you see a commercial on TV to be tested for hepatitis C, be ready for a long-term ordeal.
And hours of wondering why you have to go through the strain.