Unblocking the barriers of access to direct-acting antiviral-based hepatitis C treatment in China: Lessons learnt from Tianjin City

Background China has a substantial burden of chronic viral hepatitis. This study examines the evolution of approaches to navigate the barriers to access to direct-acting antiviral (DAA) based treatment for hepatitis C in Tianjin city, China. Methods Review of publically available literatures including published and grey literatures. On-site data extraction and key informant interview were conducted. Results Tianjin is the first area to pilot a capitated provider payment program for treatment of hepatitis C. Through which, the retirees, employees and residents spend 0.7, 1.0 and 5.6-6.8 months of their salary and disposable income for the treatment respectively. The Patient Assistance Program (PAP) eligible patients in financial hardship pay nothing for DAA, but have to pay insurance the expenditures of diagnosis and tests, and medications for adverse reactions with limited reimbursement. The PAP-eligible low-income patients who need treatment longer than 3 months have to co-pay with insurance the advance 3-month treatment before obtaining free DAA for continued treatment. By the end of March 2019, 876 hepatitis C patients registered the new insurance coverage and were treated in Tianjin, among which 153 were cured, 723 were under treatment and follow-up. Conclusions A government-led multi-party cooperation has enabled Tianjin to start unblocking the barriers. International experiences demonstrated that centralized bulk procurement is a good leverage for price negotiation, especially when innovative payment approaches are used to remove price as a barrier to access. To re-produce the above success, continued efforts are needed to develop stronger strategic price negotiation, preferably at the regional level or central level.