By: Marcus J. Hopkins, Blogger
Whenever I begin conversations about Hepatitis C (HCV) pharmaceutical costs, I use the following spiel:
The new drugs that treat Hepatitis C are phenomenal and have amazing success rates in the 90-100% range across all genotypes. That said, the first of these drugs was only introduced to the market in 2013 – Sovaldi – and it came out at a cost of $84,000 for only twelve weeks of treatment. In 2014, the next big drug – Harvoni – came out at $94,500 for twelve weeks of treatment. Since that time, newer, better drugs have been released after significantly lower prices. The cheapest, right now, is Mavyret, at $26,400 for eight weeks of treatment and $39,600 for twelve. While that is a significant reduction in the list price of these drugs, it is stillnot comparable to other conditions, like HIV. One of the newest HIV drugs, Biktarvy, is $35,839 per YEAR– for twelve MONTHS of treatment. It is essentially ¼ the cost of Hepatitis C medications per month, and what is worse is that exponentially more people are living with Hepatitis C than HIV.
When I give them this spiel, the response I consistently receive is, “FOR TWELVE WEEKS?!” “Yes,” I tell them.
The argument against using these numbers – the Wholesale Acquisition Cost (WAC) – is that, in the complicated and clandestine world of pharmaceutical pricing, WAC prices are essentially “suggestions.” The actual prices paid for these medications by insurance companies, Medicaid, Medicare, the V.A., prisons, or patients is entirely subject to very secretive, entirely confidential pricing negotiations, rebates, purchasing agreements, and other arrangements that mean everyone EXCEPT for patients paying out-of-pocket with no insurance coverage wind up paying anywhere from 15%-90% of the WAC.
Even with these steep discounts, payors have used the high costs of these medications to deny or delay treatment for patients until they are “sick enough” to merit treatment, a practice that is both highly unethical, and can result in dire long-term health consequences. But, in the U.S. healthcare system, cash is king, and profits are more important that people, both to the pharmaceutical companies who make these overpriced drugs, and the insurers who refuse to pay for them.
New research, however, has the potential to benefit patients and payors, alike: shortening treatment time maintains efficacy and decreases cost associated with treatment in 50% of patients (DiGrande, 2018). For this 50% of patients, regimen length can be reduced to just six weeks of treatment without compromising the efficacy of the drug; essentially, we can achieve roughly identical results whether treatment lasts six weeks or twelve. The resultant savings could be as much as 20%, according to the first co-author, Harel Dahari, PhD (DiGrande).
Another potential benefit of these findings is that reduced treatment durations may result in more incarcerated persons living with HCV receiving treatment. One of the (several) “tricks” state prisons and county/city jails use to deny treatment to inmates is refusing treatment based upon the time they will remain incarcerated. So, when the treatment norm was twelve weeks, if a prisoner had only six months left to serve on their sentence, they would deny treatment, because they argue that the inmate will not be able to properly initiate and complete the three-month regimen before their release. See? They won’t be able to finish it, so…I mean, GOSH…we just can’t pay for that!” Unfortunately, few Federal judges are finding that argument convincing and are consistently ruling against state Departments of Corrections, demanding that all inmates (or, in certain cases, only the specified plaintiffs) receive treatment immediately. While there is little evidence to suggest that the “time-remaining” excuse will disappear, there is always the likelihood that these findings can be used in court to successfully argue that these excuses are fallacious, at best, and illegal, at worst.
As new drugs continue to be introduced onto the market, along with the introduction of Gilead’s authorized generic versions of Epclusa and Harvoni hitting the market in January at $24,000 for twelve weeks of treatment, the potential exists that the WAC of six weeks of treatment could be $12,000 – 1/7 of the cost of Sovaldi when it hit the market. Moreover, as the drugs improve, that 50% of patients may increase, meaning that even more patients could achieve Sustained Virologic Response in half the time, for even morecost savings.
- DiGrande, S. (2018, November 16). Shortening Treatment Time Maintains Efficacy, Saves Costs in Hepatitis C. The American Journal of Managed Care. Retrieved from: https://www.ajmc.com/newsroom/shortening-treatment-time-maintains-efficacy-saves-costs-in-hepatitis-c
Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.