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The Louisiana State Capitol.

Louisiana could soon become the first state well on its way to ridding its residents of the nation's most deadly infectious disease, under an unusual proposal that, nearly two years into efforts, appears to be gaining traction.

Hepatitis C is virtually curable, but the high costs of medication have made it unaffordable for thousands of Louisiana residents who are infected and rely on the state for health care coverage.

Health Secretary Dr. Rebekah Gee has spent several months floating ideas to increase access to medication, and it appears that the state has landed on something that can win support from federal officials and pharmaceutical company heads. Gee said she believes 2019 is now a realistic goal for more affordable Hep C drugs to reach patients.

"I will probably never know what got this whole issue unstuck," Gee said in an interview with The Advocate this week. "I feel very hopeful because I have (federal health officials) and the (pharmaceutical) industry, at this point, saying 'Let's go ahead.'"

The idea is being referred to as a "subscription-based" model: The state will take the money that it currently spends toward Hep C treatment in Medicaid and the prison system, and find a drugmaker that will agree to be paid that amount for unlimited access to the medication, likely over a three-to-five year period.

"We're really optimistic that we may be the first state in the nation to get close to curing Hep C," Gee said.

Gee said some of the nation's biggest drugmakers have already expressed positive interest in the idea.

"They shouldn't care if we treat more people because they aren't getting a dime off of people who aren't being treated now," she said. "What we've come up with, we think is a win-win."

The bi-partisan National Governor's Association last week identified the subscription-based model as one of its key recommendations for states to consider as they look to improve access while ensuring fiscal sustainability.

“The Hepatitis C burden is growing in conjunction with the opioid crisis, and while the price of new treatments has come down, the cost is still far too high to treat all those who need it in our state," Gov. John Bel Edwards, a Democrat, said in a statement that accompanied the report.

The NGA report warned though that to pursue such an approach "states would need skillful economic analysis and negotiation approaches to achieve the best outcome for their residents and avoid the risk of financial commitment that does not reflect value."

The Louisiana Department of Health is currently in the process of soliciting input from the public on any potential ideas for the program. It will later select a drugmaker through a formal bid process.

Nearly 35,000 people in Louisiana's Medicaid program have the Hep C virus, which is spread through blood contamination and can lead to liver disease and cirrhosis. Because of the high cost of medication, which can run in the tens of thousands of dollars, just 384 Medicaid patients were treated for it last year.

The actual number of Louisiana residents living with the curable illness is likely thousands more – one LDH estimate put it over 70,000 residents.

"We're really optimistic that we may be the first state in the nation to get close to curing Hep C," Gee said.

Nearly half of the state's $29 billion budget goes toward health care, as about one out of every five residents, including children, the elderly and disabled, is on Medicaid.

"We ought to be in a situation where we are spending enough money we can solve whatever health challenge is in front of us," Gee said.

Gee initially made headlines when she suggested in early 2017 that the government could use a decades-old patent law to sidestep patents and cite public good to gain access to the drug at a lower price.

The proposal was met with resistance from the pharmaceutical industry, known for its intense, and powerful, lobbying efforts.

"Their job is to make sure that profits continue," Gee said. "To change the model and think about different ways, it wasn't an easy shift for the industry."

"We don't want to hamper the industry's ability to profit from cures in the future," she added.

Other experts, similarly prompted by frustration over the high cost of the treating medication, have suggested that the government could save money by purchasing a company that manufactures the drug.

U.S. Sen. Bill Cassidy, Baton Rouge Republican who specialized in hepatology as a doctor in the state's old Charity system, has also been an advocate of finding avenues to more affordable Hep C treatment. He said the benefits under the latest proposal will also extend to the state budget, which has been through chronic shortfalls and has continually directed more funding to health care.

"If we successfully treat those eligible, the state will save money down the road," he said.

U.S. Health and Human Services Secretary Alex Azar, a former drug company executive who was in New Orleans last week, described the idea as "interesting."

The plan will ultimately require approval from the U.S. Centers for Medicaid and Medicare Services, so Azar declined to discuss specifics and stressed he was unable to speak to its approval on the federal level, as no formal proposal has been submitted.

But under the Trump administration, states are being actively encouraged to be more innovative with their health care delivery with a focus on obtaining better outcomes at better values.

"What if we simply said (to states) 'Deliver this outcome?'" Azar said. "If you deliver the desired outcome, why should we be micromanaging it?"

Gee said she believes the proposal being pursued for Hep C here is akin to a public-private partnership that people will benefit from, and she hopes other states can mimic it.

"We're saying 'Here's our problem; companies, help us solve this problem,'" Gee said. "In this country right now, we really need to have companies who are willing to work with us on this."

She said she also sees potential to use the plan, if successful, as a model for access to other costly treatments.

"Our end goal is to save lives and improve health," Gee said. "For me, whatever strategy we use to reach that goal is good."


Follow Elizabeth Crisp on Twitter, @elizabethcrisp.