The following testimony was delivered by Dr. Vera Antonios at a meeting of the New York State Medicaid Drug Utilization Review Board on April 27, 2016 in Albany.
Since its founding in 1988, Harlem United has grown to serve over 16,000 clients per year by providing quality healthcare, housing, and social services. The vast majority of our clients are socioeconomically disadvantaged people of color living in Harlem and the South Bronx who are Homeless or unstably housed, in extreme poverty, and living with HIV/AIDS and/or other chronic conditions such as Hepatitis C.
Harlem United serves this community with over 700 units of supportive housing, health care centers and mobile units providing medical, dental, and mental health services, harm reduction, testing services for HIV and other STIs, syringe exchange, and community outreach.
Harlem United has been treating Hepatitis C since 2010, but the program ramped up in 2014, with new medications coming on the market making treatment less problematic and more successful. Since then, we have served over 200 clients, majority Black or Hispanic men between the ages of 40 and 60, mostly infected through intravenous drug use, and with approximately 50% co-infected with HIV.
We believe all of our clients should receive treatment and be cured, and we work with them on achieving readiness to start medications. This includes addressing substance use, mental health problems, and comprehensive education. Patient navigators keep clients connected to care by escorting them to appointments or tests, weekly support groups, and navigating the complicated path of prior authorization. Nursing staff help with medication management, which can include Directly Observed Therapy, as well as checking regularly on clients on treatment to ensure they remain adherent.
It is challenging to get a client who is homeless or actively using drugs to complete a treatment that is 12 weeks on average, but at Harlem United we know it is feasible. We have treated 86 patients and cured 57 so far, while the others remain on treatment. However, our biggest challenge is procuring authorization for the medication from insurance providers.
The majority of our clients are enrolled in New York State Medicaid managed care plans. Some insurance plans continue to deny clients treatment despite several appeals. Some clients may never receive the medication at all until they switch to another plan. We have had denials from Fidelis for two clients, one of whom is co-infected with HIV, a category that’s considered a high priority to treat. Other denials were from Affinity Health Plus. We also have had good responses and support from other insurances like Metroplus and Amida Care.
This treatment is effective, and it cures over 95% of clients. It prevents liver cirrhosis and liver cancer. Every person with Hepatitis C should have access to treatment. It improves people’s lives and the community health, and it is cost effective in the long term for our health care system.