Hepatitis C is a blood-borne virus. Today, most people become infected with the Hepatitis C Virus (HCV) by sharing needles or other equipment to inject drugs. But, according to the Centers for Disease Control, baby boomers seem to be at higher risk – your clients could be infected and not even know it!
The CDC explains people born from 1945-1965 are five times more likely to have HCV than other adults. The reason is not completely understood. “Baby boomers could have gotten infected from medical equipment or procedures before universal precautions and infection control procedures were adopted. Others could have gotten infected from contaminated blood and blood products before widespread screening virtually eliminated the virus from the blood supply by 1992,” the CDC says. 1
The Hepatitis C virus is a common, infectious virus that targets the liver; still this illness can appear in many other body systems and organs. Studies have found that between 70 and 74 percent of those with Hepatitis C experience extrahepatic (outside the liver) manifestations which could affect the brain, eyes, thyroid, joints and muscles, digestion, glucose control and the hands and feet.2
For some people, hepatitis C is a short-term illness, but for 70-85 percent of people who have HCV, it becomes a long-term, chronic infection.3 Chronic HCV is a serious disease than can result in long-term health problems, even death. Unfortunately, the majority of infected persons may not even be aware that they are infected as they do not feel ill nor do they experience chronic symptoms.
There is no vaccine for Hepatitis C. The best way to prevent it is to avoid behaviors that can spread the disease, especially injecting drugs.
Harvoni (ledipasvir/sofosbuvir) is currently one of the most advertised prescription treatments for HCV and has shown tremendous results. In clinical studies, most patients with HCV genotype 1 who had no prior treatment were cured with just 12 weeks of therapy. Most infected patients are experiencing little side effects and are able to tolerate the medication.
Unfortunately, the cure rates are not as high for people with cirrhosis who were previously treated unsuccessfully with interferon-based hep C regimens, people with decompensated cirrhosis and those with genotype 3 of hep C.
The typical treatment window is 8-12 weeks, with many patients clearing the virus (negative HCV RNA) as early as eight weeks. Once the HCV RNA has been negative for greater than six months after treatment, a person is considered to have sustained viral response (SVR) and is essentially cured.
Underwriters will consider multiple factors and test results when assessing the risk for an applicant with a history of HCV.
Aside from factors such as date and age of onset, symptoms, and prior treatments, they will also review serology, imaging (US/MRI/CT), biopsy results and scans. Today, there are more sophisticated blood tests (FibroSURE) and scans (FibroScan), which will measure liver damage (fibrosis and cirrhosis); these advances have significantly reduced the need for invasive, costly and riskier needle biopsies.
Applicants who have successfully cleared the virus (sustained neg HCV RNA more than six months) with no liver damage may be approved at preferred rate classes! (Depending on the carrier)
Applicants unable to clear the virus are considered chronic hepatitis C applicants and will be rated and possibly declined, depending on the individual’s overall factors and test results.
At Ash Brokerage, you have a dedicated staff of seasoned underwriters available to answer your questions regarding your clients with Hepatitis C. We’d welcome the opportunity to talk with you about your client’s specific needs. Also, be sure to check out our helpful questionnaire to use with your clients.
Ash Brokerage Hepatitis Questionnaire: http://go.ashbrokerage.com/WC2017-07-UW-Hepatitis_LP-Content.html?utm_source=blog&utm_medium=landing_page&utm_campaign=uw_questionnaire
1Centers for Disease Control and Prevention, “Know More Hepatitis”: https://www.cdc.gov/knowmorehepatitis/media/pdfs/factsheet-boomers.pdf
2HCV Advocate, “HCSP Fact Sheet, Extrahepatic Manifestation of HCV” July 2015: http://hcvadvocate.org/hepatitis/factsheets_pdf/extrahepatic.pdf
3CDC, Viral Hepatitis, Hepatitis C: https://www.cdc.gov/hepatitis/hcv/index.htm
4Centers for Disease Control and Prevention, “Testing Recommendations for Hepatitis C Virus Infection”: https://www.cdc.gov/hepatitis/hcv/guidelinesc.htm
For more than 35 years, Charlie Kuhn has taken a personal interest in every case. To her, it’s more than a file – it’s a person trying to protect the people they care about, or a business trying to protect its future and the future of their employees. Charlie can think of no better vocation than to help provide financial and emotional security for others. Through her personal commitment to continuous professional growth, Charlie is one test away from becoming an Associate of the Life Management Institute. She is already an Associate of Customer Service with LOMA, has passed all three of the Academy of Life Underwriting exams, and is certified in EKG interpretation.
Hepatitis C is the most common bloodborne disease in the United States and is also the most frequent type of hepatitis we see in underwriting. What is it? An inflammation of the liver that may be acute and mild, or a more serious chronic type that attacks the liver.
Hep C virus (or HCV) is spread primarily through contact with blood of an infected person. It’s often called the “silent epidemic” because no symptoms are present until the disease progresses. If not identified early, it may lead to cirrhosis of the liver or liver cancer, which may require a transplant.
A few years ago, the outlook for treating chronic Hep C was less favorable. Patients would have to undergo protocols of injections and multiple pills a day with major side effects for almost a year. There would then be a six-month follow-up period to evaluate if treatment was a success. The cure rate was only 50 percent.
But, we’ve come a long way! Due to research in the field, many patients can now be cured with direct-acting antiviral drugs, a less potent combination in one or a few pills for only a few months. Cure rates are about 95 percent for most patients. FDA approved anti-viral drugs include Harvoni, Olysio, Viekira Pak, Zepatier and Daklinza. There also continues to be research for patients who don’t respond well to this new treatment protocol.
Depending on the type and specific details of a client’s hepatitis history, life insurance carriers will give possible consideration of coverage, some even qualifying without a rating. With the significantly improved cure rates associated with new treatments, we have seen several carriers update their risk philosophy specific to hepatitis with reduced/eliminated postpone periods after treatment and more clients qualifying for non-rated coverage.
Generally, the most favorable clients include those who have completed treatment with documented stability through interval lab testing, which shows normal liver function results (AST, ALT and GGT). Carriers also like to see an undetectable viral load (HCV RNA or HCV PCR), which measures the amount of virus in the bloodstream.
Important factors of consideration also include date of diagnosis, disease duration, liver biopsy results (if any), type of treatment (if any), date of last treatment, current/historic alcohol use and overall control/compliance of care.
To make your next case a little easier, view our Hepatitis Questionnaire with your client, then contact your Ash Brokerage team. We’re ready to help!
Lisa Oleski has been brokerage underwriting for the past 20 years. She is passionate about treating each case she touches as an opportunity to exemplify the Ash difference, with the ultimate outcome of finding the most favorable solutions for advisors and their clients.
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