States, insurance plans wrestle over decisions to offer costly hepatitis C drug

Jun 16 2014

The medication, named Sovaldi, has shown great promise in fighting the deadly disease, but it is very expensive: The treatment regimen runs about $84,000 per patient.

The Wall Street Journal's Pharmalot: Will Oregon Restrict Coverage For A Pricey Gilead Pill For Hepatitis C?
Mention the Sovaldi hepatitis C pill to insurers and you are certain to hear complaints. The Gilead Sciences treatment has excited Wall Street amid the promise of a booming, multi-billion-dollar market for drugs to cure the disease. But the flip side of this excitement is a great of fretting over the cost – $84,000 per patient. Even though Gilead argues this is cheaper than alternative remedies, such as liver transplants, payers are complaining to no end (Silverman, 6/12).

McClatchy: New Hepatitis C Wonder Drug Shakes Up The Health Care Industry
In the first quarter of 2014, 30,000 U.S. patients were treated with Sovaldi, generating a whopping $2.3 billion in sales for Gilead, of Foster City, Calif. The company says Sovaldi's price reflects its 90 percent-plus cure rate for hepatitis C and the savings that produces by cutting patients' long-term treatment costs, which can include hospitalizations, surgeries and even liver transplants. But private insurers, drug benefit managers, health care advocates and Medicaid officials say the drug's steep price tag will drive up insurance premiums, limit patient access and squeeze the budgets of state Medicaid programs, which have a disproportionate share of hepatitis C patients (Pugh, 6/12).

In related news -

Kaiser Health News: Capsules: PhRMA, Advocates: Specialty Drug Costs For Patients Too High
Here's the next salvo in the back and forth between insurers and the drug industry over drug prices: the Pharmaceutical Research and Manufacturers of America are pushing the Department of Health and Human Services to take action to protect consumers who have gained insurance via the health law's online marketplaces from high, out-of-pocket costs for specialty drugs (Gillespie, 6/12).