Dr. Ronald Cirillo and his assistant at the Turning Points free clinic in Bradenton are testing another patient for hepatitis C.
"It's a simple test, the risk factors are next to none,” Cirillo says. “It's a finger stick, the same way you would do for diabetes and checking your blood."
Since arriving at the clinic last year, Cirillo has been on a mission to eradicate the virus, which damages the liver and can be fatal.
So far, the clinic has treated dozens of patients with a drug called Harvoni, which cures up to 98 percent of people with hepatitis C.
Though the drug’s $94,500 cost puts it out of reach of the uninsured patients who use the clinic, the drug’s maker, Gilead Sciences, provides it for free to qualified, low-income patients.
That’s why Cirillo and his staff have been pricking the fingers of every high-risk patient that will agree to take the test.
One of those patients, Patricia, 57, learned she had the virus a few months ago. Patricia declined to use her last name because of the stigma surrounding hepatitis C, which can be transmitted through IV drug use.
"So just because of my age, I guess, they went ahead and tested me for it and it blew my mind that I actually had hep C,” Patricia said. “And the levels ended up being really high."
Patricia doesn’t know how she acquired the virus, which was also spread through blood transfusions before 1992 and unprotected sex. She believes she may have had it since birth.
And that’s what makes the virus so dangerous: It often goes undetected until it has caused irreversible damage. In Patricia's case, it had started to scar and inflame her liver.
Without a job or insurance, there was little chance that she would get the cure without help from the clinic.
“I would never have been able to afford that treatment,” Patricia said. “Never.”
The clinic's staff helps patients fill out the complicated application. Patients must have no insurance, be drug free for at least six months, and meet income requirements.
Patients who receive the Harvoni treatment take one large pill a day for 12 weeks. Patricia recently completed the treatment and will be tested again in three months to determine whether she is free from hepatitis C.
“Had they not discovered it, really, and gotten me onto the program, who knows, you know,” she said.
So far, Gilead has not turned down any of the roughly 100 patients who have applied through the Bradenton clinic over the past two years. By comparison, Medicaid covered the Harvoni treatment for 1,277 patients statewide over the past two years.
(Editor's note: This story has been updated with the correct number of Medicaid patients covered by the Harvoni treatment over the past two years.)
Gilead representatives declined to be interviewed for this story but released a statement that said the company is committed to providing access to treatment for patients who can't afford it.
Gilead isn't the only pharmaceutical company that participates in these patient-assistance programs.
In 2014, patient-assistance programs were available for more than 300 drugs, at a cost of about $4 billion per year to the manufacturers, according to a report in the New England Journal of Medicine.
Everyday, free clinics throughout Florida secure thousands of dollars worth of these medications from drug companies at no cost.
Just north of Bradenton, at the St. Petersburg Free Clinic, Roslyn Hunter is assigned full-time to negotiate with drug companies on behalf of patients. Each year, she secures millions of dollars in free drugs.
“Out of the applications that I submit, I'm usually 90-95 percent successful in getting drugs for the patients,” Hunter said.
Patients there and at other clinics across the state are getting help treating common conditions like diabetes and high blood pressure.
But the Bradenton clinic has focused on providing the hepatitis treatment in part due to Dr. Ronald Cirillo.
Cirillo specialized in hepatitis treatment for more than 30 years before retiring and moving to Florida. During that time, the available hepatitis C treatment had terrible side effects and was only about 30-40 percent effective.
When Harvoni was released in 2014, he knew it was big.
“It's the reason that dragged me out of retirement,” Cirillo said. “This is easy guys, what do you need here. … We have the cure, the disease is out there, my job is to get the disease in here so we can follow them and treat them.”
That's why he's hanging posters in a soup kitchen and job center associated with the clinic and why he'll test any qualified high-risk patient that walks in his door.
This story and the “Their Only Option” series is produced as a project for the University of Southern California Center For Health Journalism’s National Fellowship.
