September 1, 2016

Secretary Hillary Clinton
Hillary for America
Post Office Box 5256
New York, NY 10185-5256

Dear Secretary Clinton, As a national group of healthcare providers, advocates, and patients dedicated to preventing and treating viral hepatitis, we welcome your recent comments in Cleveland regarding the high price of pharmaceutical drugs to cure the hepatitis C virus (HCV). We are encouraged by the broad support for government action on the high price of pharmaceutical drugs, especially those for viral hepatitis, and to see this issue being directly addressed by elected officials at all levels of government. However, we are writing you today out of concern that your current healthcare platform does not specifically or adequately address the national and international viral hepatitis epidemics. We must work together to raise the profile of hepatitis B and C as urgent public health priorities.

As you may know, chronic viral hepatitis affects 3.5 to 6 million Americans and is the primary cause of liver cancer in the United States. Unlike most other kinds of cancer, liver cancer incidence and death rates are on the rise in our country. Despite having a vaccine, many people are not protected against the hepatitis B virus (HBV), with significant global need for birth dose vaccine to prevent mother to child transmission, and to improve vaccination coverage among young adults in the U.S. Despite having a cure, HCV kills more people in the United States than any other infectious disease, including HIV-related illness. 50-75% of Americans living with HBV or HCV do not know their status. Funding for the CDC’s Division of Viral Hepatitis has not kept pace with the increased infection rates in Florida, Ohio, Pennsylvania and many other states. As we write, the National Academy of Sciences is drafting their forthcoming National Elimination Strategy for Viral Hepatitis, which can only strengthen federal and state-based efforts to progress towards this shared goal. But plans and strategies can only take us so far; without political commitment and resources, HBV and HCV will continue to spread, causing needless illness and death.

We must overcome all barriers to preventing, identifying, and treating HBV and HCV, including vaccinating all adults and newborns at risk for HBV, and curing everyone living with HCV. These barriers include high drug prices; restrictions on treatment access, especially for those on Medicaid; and lack of infrastructure for viral hepatitis prevention, surveillance, testing, and treatment. The Centers for Medicare and Medicaid Services (CMS) released guidance on November 5, 2015, to ensure access to HCV treatment for Medicaid beneficiaries, but the guidance has not been enforced or implemented nationwide. It is crucial that Medicaid beneficiaries living with HCV have access to the cure regardless of where they live, and without restrictions based on disease progression or sobriety requirements. In 2014, the U.S. Preventive Services Task Force gave a “B” grade for screening all adults at high risk for HBV infection. On July 7, 2016, CMS proposed that Medicare cover HBV screening. This is a significant advance in efforts to identify those with chronic HBV infection and link them to treatment. It is critical that all high risk individuals have access to hepatitis B screening as an additional preventive service.

Beyond the health care system, some of the greatest barriers to the elimination of HBV and HCV are lack of culturally appropriate and responsive services (e.g., HBV disproportionately impacts people of Asian, Pacific Island, and African descent and HCV disproportionately impacts Native American and African American communities); the criminalization of drug use; lack of appropriate harm reduction and syringe exchange programs; and the social stigma related to HBV and HCV. We appreciate that you have included substance use disorders and criminal justice reform in your existing platform, but we urge you to go further.

• We ask that you consider adding to your healthcare platform explicit support for eliminating HBV and HCV both nationally and internationally. Nationally, we urge you to review the recommendations from the National Academy of Sciences and commit to the goal of eliminating HBV and HCV in the United States. Globally, we urge you to support the World Health Organization’s (WHO) stated goal of eliminating HBV and HCV as global public health concerns by 2030, with measurable targets.
• We ask that you support the enforcement of the CMS Guidance released on November 5, 2015, titled “Assuring Medicaid Beneficiaries Access to Hepatitis C (HCV) Drugs.” CMS should be required to take action in those states which are refusing to move their drug utilization policies into compliance with the requirements of the Social Security Act, as articulated in the Guidance.
• We ask for your ongoing commitment to ensure affordable access to medically necessary drugs and that you make all efforts, including executive actions, to ensure significant price reductions and remove high prices as a barrier to ending the viral hepatitis epidemic.
• We also respectfully ask for the opportunity to bring a small group of viral hepatitis experts and advocates to meet with your health policy team to discuss specific policy proposals and needed resources to address viral hepatitis domestically and abroad.

With your leadership, and your unique ability to call attention to these national and global epidemics, we can establish national and international policies that address and eventually eliminate viral hepatitis.

Sincerely,
Annette Gaudino Co-Director, HCV Projects
Treatment Action Group

ACRIA, Marcus Rodriguez, New York, NY

ACT UP, Andrew Velez, NEW YORK, NY

ACT UP New York, Luis Santiago, New York, NY

AIDS Action Baltimore, Lynda Dee, Baltimore, MD

AIDS Community Research Consortium (ACRC), Megan O’Day, Redwood City, CA

AIDS United, Ronald Johnson, Washington, DC

Alameda Health System, Amy Smith, Oakland, CA

Albany Damien Center, Inc., Perry Junjulas, Albany, NY

Amida Care, Doug Wirth, New York, NY

Apicha Community Health Center, Therese R. Rodriguez, CEO, 400 Broadway, NY

Asian Health Services, Anita Chang, MD, Oakland, CA

Blue Faery: The Adrienne Wilson Liver Cancer Association, Andrea J. Wilson, Birmingham, AL

Blue Shield of CA, Kimberly Grider, RN, CCTC, CCM, Rancho Cordova, CA

Bronx Parent Housing Network, Socrates A. Caba, Bronx, NY

C.O.R.E. Medical Clinic, Inc., Garrett Stenson, Sacramento, CA

California Academy of PA’s, Ana Maldonado MPH, DHSc, PA-C, San Francisco, CA

California Pacific Medical Center, Andy Liu, MD, San Francisco, CA

Callen-Lorde Community Health Center, Kimberleigh Smith, New York, NY

Capitol Gastroenterology, Sidney Yassinger, MD FACP, Carmichael, CA

Caring Ambassadors Program, Lorren Sandt, Oregon City, OR

CCARE, HARKIRAT BAL, FRESNO, CA

Center for Health Law and Policy Innovation of Harvard Law School, Robertr Greenwald, Cambridge, MA

Charles B. Wang Community Health Center, Amy Tang, New York, NY

CHOW Project, Heather Lusk, Honolulu, HI

Cincinnati Exchange Project, Judith Feinberg MD, Cincinnati, MP

Community Health Action of Staten Island, Diane Arneth, Staten Island, NY

DOH, Tamara Whitney, Kaneohe, HI

East Bay Center for Digestive Health, Lynne Tavera, Oakland, CA

El Punto en la Montaña, Gladys Nieves-Vázquez, San Juan, PR

El Punto en la Montaña, Alexandra Rodríguez-Romero, Puerto Rico, PR

El Punto en la Montaña, Camila Gelpi-Acosta, PR, PR

End AIDS Now, Alan Timothy C Lunceford Stevens, NEW YORK, NY

Exponents, Howard Josepher, LCSW, New York City, NY