Camino and Rocky3,
As you say, a cliff is likely because new infections are and have been declining for many years. The uncertainty is when does the cliff appear. Many factors that will control that. To me, of prime importance is which specialties will treat HCV in the future? Hepatologists and maybe Gastroenterologists with appropriate experience? Seems appropriate to me and Kaiser is doing that. If so, you have a gate on the flow of patients. There are only so many of these specialties and HCV is not the only thing they treat. And one wonders what was the telaprevir experience – what specialties prescribed that? If any GP or IM could prescribe, the cliff would be much sooner, but I seriously wonder about the quality of care.
I also wonder if PBMs could legally insist that only appropriately trained docs prescribe the new meds.
I have not seen any real analysis of the additional load that hepatologists and Gastroenterologists could manage, but I suspect it has been done, and I think that is what will determine the distance of the cliff.