is it, thanks to the miracle of modern medicine and plain, old
Hepatitis C was pretty much limited to a combination of pegylated
interferon and ribavirin. The result usually causes painful,
debilitating side effects such as flu-like symptoms, depression, and
anemia for the six to twelve months of the treatment course. After all
that, Genotype 1 patients had about a 45% chance of success with
pegylated interferon and ribavirin. Genotype 2 or 3 patients had around
75% chance of success with the same combination–neither a great success
on the market, which can honestly be labeled “wonder” drugs. A
twelve-to-twenty-four week course of treatment with Sovaldi
(sofosbuvir) and/or Olysio (simeprevir) is successful in about 90% of
the patients taking them, accompanied by little or no painful side
That was the good news. And now……
pharmaceutical manufacturer, has priced Sovaldi at $1,000 for each
slim, yellow pill. A course of treatment is one pill daily for twelve
weeks for a total retail cost of $84,000. A course of treatment on
Olysio is $66,000 as priced by its maker, Janssen Pharmaceutical
Companies. Treatment costs could reach $150,000 if both medications must
payers of medications has sent shock waves throughout the healthcare
industry and government medical programs. Adding to the concern is that
there are an estimated 3.2 million people in the United States
infected with HCV, although that is just an estimate since up to 50% of
those infected are not aware of their infection. Either way, HCV
currently kills more people each year than does HIV.
HCV were given the course of treatment with Sovaldi, the total cost
would be about $227 billion. This is an alarming number given that each
year only slightly more than $250 billion is spent on all medications prescribed in the United States.
affected by HCV infection is the Baby Boomers, persons born between
1945 and 1965. There was a study recently done on the impact of
offering these medications through Medicare Part D Prescription Drug
Plans as this group ages and is becoming eligible for Medicare.
Assuming 270,000 beneficiaries of Part D plans are HCV infected,
federal spending on the Part D Program could double to over 5 ½ billion
Part D coverage adding another $20 to $30 dollars per month per person.
Congress, when it passed the Medicare Part D law, prohibited the
insurers from attempting to negotiate discounts of the “regular” price
as does the Department of Veteran’s Affairs, so people on Medicare will
be forced to pay the higher premiums the insurance companies will have
to charge in order to cover the new medications.
similar impact on private health insurance. Private health insurance
companies are particularly concerned. The manufacturer and the “Big
Pharma” lobby insist that the $84,000 price tag on treatment is cost
effective compared to treating a patient over the long term as the
patient’s condition worsens and perhaps requires a liver transplant,
which can cost over $500,000. However, these long-term savings will
only benefit Medicare as this population reaches age 65, not the
insurance companies who would be paying for the cure.
state Medicaid plans and the country’s prison population due to HCV’s
most frequent mode of transmission. For example, Oregon has 5,600
people on Medicaid with HCV, but estimates about 13,000 are infected
and do not know it. This is out of a total of 600,000 on Medicaid in
Oregon. By their estimation, they could spend what they currently spend
on all medications in Medicaid and still only help about 25%
of the infected population. The National Association of Medicaid
Directors speculates that Sovaldi alone could double every
state’s Medicaid pharmacy budget if they were forced to provide it to
every HCV infected member including those who are asymptomatic.
didn’t mention that part of the reason HCV has infected so many people
is that, like HIV before it, the method of transmission has caused the
infection to be unjustly stigmatized by society. As a result there has
been a general reluctance to discuss the disease and a lack of public
education about HCV and its prevention.
they could go bankrupt if they were forced to provide the treatment to
every HCV-infected, insured member without substantially increasing
every insured person’s premiums. How valid that claim is can be
questioned; however, Gilead’s price for Sovaldi is set very high, so in
the absence of price reductions, health insurance rates will certainly
is the price of the medications in the United States. Why is the price
set so high? It has been estimated that each pill costs about $130 to
offered to many, there is a still substantial profit margin. The
Veteran’s Administration has negotiated a 40% discount on the cost for
veterans. The European Union negotiated a 50% discount in the European
countries and the United Kingdom. Other countries have enacted laws
that put a cap on what can be charged for medications.
lowered for the public in the future is still unknown. Gilead has
resisted requests to explain their pricing structure. Turning up the
pressure on them, the Senate Finance Committee has formally written to
the manufacturer asking for a justification of Sovaldi’s price.
which is being used by some Medicaid plans and is also being
considered by some health insurance carriers, is to restrict the
coverage of the medication. They are only covering it when the
patient’s condition is becoming severe and the patient is or will soon
be a candidate for a liver transplant.