— -- For Pamela Anderson, a Hepatitis C diagnosis seemed liked a death sentence.
“They said I would die in 10 years,” Anderson said. “When someone tells you something like that you kind of act differently subconsciously.”
Hepatitis C is a chronic viral infection of the liver that affects an estimated 3.5 million Americans, and roughly 15,000 people die from it each year, according to the Centers for Disease Control and Prevention.
Anderson has lived with the virus for more than 15 years, but three months ago she learned that she had been cured of the virus after completing a 12-week regimen with a drug called Sovaldi.
“Twelve weeks and gone, yes,” she said. “I feel like I got back 20 years back of my life.”
Anderson said the treatment cost around $100,000 and was covered by her health insurance. Healthy once more, Anderson is back focusing on projects like her cooking show and vegan shoe line.
But not everyone is so lucky.
Shima Andre, a 42-year-old Hepatitis C sufferer living in California, has health insurance and was prescribed an alternate version of the drug called Harvoni, but she was originally denied coverage after her disease was not deemed advanced enough to warrant approval under her policy.
“They basically told me that I had to reach a certain level of scarring in my liver,” she said. “They want me to be right on that ledge right there before they throw me these pills.”
While Anderson paid nothing, Andre was being asked to pay almost $100,000 out of her own pocket for the same treatment, which begs the question why patients pay different prices for the same medication.
Insurance companies, with their purchasing clout, can try to negotiate with the drug makers for lower prices on prescription drugs. Private drug companies are allowed to set the prices for medication as they see fit and it’s up to private insurance companies to determine how they want to cover the costs. But the law mandates that government-funded programs like Medicare are prohibited from negotiating prices.
“Unlike every other insurance company, the 38 million people in Medicare are not getting the best prices for their drugs and the government isn't getting the best prices for their drugs because the government can't negotiate on behalf of all of those Medicare beneficiaries,” said Joe Baker, the president of the Medicare Rights Center.
For five years, Congressman Fred Upton, R-Michigan, the chairman of the House Energy and Commerce Committee, has prevented any bill that attempts to change that law from getting to a vote. Just in 2014, he received more than $300,000 dollars in donations from drug companies -- the most of any House member that year, according to The Center for Responsive Politics' website, OpenSecrets.org.
When confronted a few months ago, Upton told ABC News he was working on a bill of his own that will “lower the cost of drugs” and fix the prescription drug price problem. He pointed out that in his home state of Michigan, drug giants Pfizer and Stryker are two of the largest employers.
But ABC News looked into his bill and there were no provisions to allow Medicare to negotiate lower prices. Upton’s office did not return ABC News’ request for further comment.
As for Andre, her insurance company changed its mind after ABC News became involved, and now says it will cover Andre for her Hepatitis C medication.
“There was an email sent out wanting to know when the taping was and when it was going to air,” Andre said. “All of a sudden, I got a phone call, I’m approved, my prescription is ready, all this stuff, I’m like yes, this is amazing.”
Her insurance company told ABC News in a statement that “the benefits of prescribing Harvoni for women of child-bearing age potential...outweigh the risks and we have revised our coverage policy.”
Andre did finally receive the medication, and just last week she was told she no longer has Hepatitis C.
But unlike Andre’s insurance company, Congress has not changed its position. There are others who continue to struggle, something Pamela Anderson believes can be fixed.
“There are not too many cures for viruses like this,” she said. “I think it’s the beginning of a lot of great things.”
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