Thousand-dollar hepatitis pill just became even harder to get

[The title was written by my editor.]

An effective and extremely costly drug has cleared many patients of the hepatitis C virus, but its high cost has Oregon officials backing away from covering it under the state’s Medicaid program.

by John Tyburski

Copyright © Daily Digest News, KPR Media, LLC. All rights reserved.

First published at Daily Digest News on July 31, 2014

So good yet so out of reach–this describes what may become a common problem with a drug that has been demonstrated to be extremely effective in treating hepatitis C infections. In May, officials with the U.S. Medicare program raised concerns about the cost of a drug called Sovaldi used to treat hepatitis C. More recently, California officials lamented that to cover the cost of access to this drug under its Medicaid program, called Medi-Cal, would cost state taxpayers an estimated $6.7 billion.

Now Oregon is taking the next step and declaring tight restrictions on who can receive Sovaldi under Medicaid coverage. Sovaldi costs as much as $1,000 per pill and is made by California-based Gilead Sciences, Inc., makers of the high-cost drug used in HIV pre-exposure prophylaxis called Truvada.

Experts on Oregon’s pharmaceutical review committee have questioned whether the high cost of the drug is justifiable and feasible on strained Medicaid budgets. Officials estimate that treating the state’s hepatitis C-positive Medicaid enrollees for one year will cost the same as what is typically spent on all other drug coverages combined in 2013.

Oregon joins the Illinois Medicaid program in establishing strict policies on Sovaldi coverages. Patients must meet 25 separate criteria in order to qualify for prior approval to receive the drug paid for by the government.

Matt Salo, director of the National Association of Medicaid Directors, said that Medicaid officials are accustomed to covering the costs of expensive treatments for rare conditions. The problem with hepatitis C is that it is not a rare condition.

“It’s always been 50 people or 500 people or 1,000 people, not hundreds of thousands like we’re seeing (with Sovaldi),” Salo said. “So this is kind of a game-changer.”

When used to treat hepatitis C infection, Sovaldi is taken once per day for 12 weeks along with two other companion medications. The cost for one patient totals around $100,000.