When the Food and Drug Administration approved a medication called Sovaldi, it was hailed as a breakthrough in the fight against hepatitis C, a blood-borne disease that affects 3.2 million Americans and kills more people in the U.S. annually than AIDS. That was until Gilead Sciences, the manufacturer, announced the price: $84,000 for a 12-week course which is more than what many cancer treatments cost in a year. Guess what the insurance companies said: uh no.
Hefty Price Tag
The hefty price tag is due to the prescription drug being targeted for a smaller patient population. The price tag is high in order to return the amount of money invested in the research of the drug. Since there are fewer people who will be treated then the price tag is larger. Some say that this takes greed to a whole new level. At least one prescription drug plan is encouraging doctors to delay prescribing Sovaldi for patients who can wait. One insurer claims it risks bankruptcy if it’s required to cover the drug for everyone who needs.
The prescription drug has also prompted a new round of discussions over a larger issue: the escalating cost of specialty drugs. These drugs are designed to treat chronic illnesses such as rheumatoid arthritis and multiple sclerosis and sometimes require special handling. While these therapies are delivering body blows to some of the world’s most dangerous diseases, they also are testing the limits of what society is willing to pay for sought-after treatments or cures.
Rich Get Healthier
The advancements that are coming in medicine are going to be stunning and amazing, both in terms of the kinds of things we can treat that we never could before. In the past, treating hepatitis C was not always successful and involved lengthy treatment with injectable drugs that had significant side effects. By contrast, Sovaldi promises to cure nearly all sufferers with a once-daily pill that has far fewer side effects.
Gilead said the price is fair because it is a significant improvement from previous treatments and it is not more expensive than the old treatment over time. Gilead added that it offers a generous assistance program to help low-income people get the drug at a low cost. But seriously $84,000 for 12 weeks. So if you need 24 weeks it is $168,000. I don’t see it as a problem for those making $500,000 a year. It is a hit but worth it considering the financial position to be in. The average household who makes $50K-$100K will be locked out of this medication.
Many people contracted the disease through blood transfusions before routine testing of donated blood for hepatitis C began in 1992. The disease can go undetected for years and can eventually lead to cancer or cirrhosis of the liver. It is particularly prevalent among baby boomers. Federal health authorities recommend that everyone born between 1945 and 1965 be tested for the disease.
Molina Healthcare, a company that operates Medicaid managed-care plans, has told state officials it cannot bear the cost of covering the drug. The company, which gets a flat fee from states for each Medicaid recipient, negotiated its 2014 rates before the FDA approved Sovaldi. It is asking states to pay for the drug separately and is deciding whether to cover the drug at all.
Express Scripts, the nation’s largest prescription drug benefit manager, has said it is encouraging some doctors in its networks to delay prescribing Sovaldi for hepatitis C patients who can safely wait. It is the first time the company has asked doctors to avoid a drug because of the cost.
How good is your healthcare plan?