Oregon Medicaid targets expensive hepatitis drug

[Judi Lynn]

Source: Associated Press

Oregon Medicaid targets expensive hepatitis drug
Posted: Jul 31, 2014 2:30 PM CDT
Updated: Jul 31, 2014 2:45 PM CDT

By JONATHAN J. COOPER
Associated Press
WILSONVILLE, Ore. (AP) - An Oregon Medicaid committee is expected Thursday to significantly scale back access to an effective - but expensive - new drug used to treat hepatitis C.

The decision would allow only a narrow set of Medicaid patients to be treated with the $1,000-per-pill drug known as Sovaldi, made by Gilead Sciences Inc.

Medical experts on Oregon's pharmaceutical review committee question whether the drug is worth the price tag, and officials worry it would break the bank. They say treating all Medicaid patients with the liver-wasting disease would cost almost as much as last year's entire drug bill.

Oregon's guidelines would allow the drug to be used only for patients with later stages of liver damage who have been compliant with previous medical treatments and drug-free for at least six months. The drug could only be prescribed by a liver specialist.


Read more: http://www.wlns.com/story/26165081/oregon-medicaid-targets-expensive-hepatitis-drug

[Blue Idaho]

1. For-Profit Pharma is really working Great!

Why is it that this drug costs $1,000 per dose in the US. That's roughly $100,000 to treat one person. Meanwhile, in Canada and England the same course of treatment costs $55,000. Now hold on to your hat - the same course of treatment costs... Are you ready for this? $900 in Egypt. That's it - $900. How can it cost so little in Egypt? Well, it costs Gilead $130 to manufacture enough of the drug to treat one person.

Isn't it about time someone asked some hard questions?

[crazylikafox]

3. ^^^This^^^

[Psephos]

7. Gilead offers Egypt that price for humanitarian reasons.

Egypt has one of the highest Hep C infection rates in the world. Gilead claims they want to do something about it. My guess is they like the PR as much or more than the humanitarian pride.

Gilead is also working with Indian generic manufacturers to produce a low-cost generic version of Sovaldi to make the drug fit third-world budgets.

http://www.reuters.com/article/2014/03/21/us-hepatitis-egypt-gilead-sciences-idUSBREA2K1VF20140321

I don't know the underlying reasons for the cost nor do I care to defend Gilead. But I hate the laziness of not bothering to look past the indignance meme and learn the whole story. As with most issues, demonization does not bring clarity, it prevents it. This story is clearly a (typically) mixed bag.

On a larger scope, the way US regulations and the fee-for-service industry model shape US pharma conduct has led to similar outcomes compared to the movie industry, which has been shaped by the summer blockbuster phenomenon. In both cases, simple, vital, but "unsexy" product development is pushed aside in favor of long-shot home runs. Companies spend insane millions on a lot of duds, often risking bankruptcy, with an expectation that they will make it all up with a hit. That's due to a large degree to the cost of meeting development regulations over the typical decade or more the process takes - without any sales during that period.

Big companies actually like this regulatory scheme. It keeps the drawbridge pulled up and inhibits the entrepreneurial start-ups.

Pharma helped write ACA, and our own Senators were bribed into making it a sweet deal for big medicine and big insurance. If you want cheap Sovaldi, that's a good place to start. Next, start looking at the oligarchic-friendly regulatory incest between FDA and pharma. Those who think ACA and FDA are looking out for the little guy, need a stiff dose of meds themselves (or electroshock therapy).

[Hoyt]

2. The bright side, as USA becomes poorer from this kind of stuff, the price will fall.

I think Oregon is making the right move at this time.

[FarPoint]

4. The Hep C cocktail treatment is difficult to endure...Duration 6-9 months.

They must comply with the strick oral medications and the weekly injection. The treatment makes you feel ill to put it mildly. Ultimately.. Non- compliance takes place resulting in failed treatment and loss of financial investment. So...I understand.

[Blue Idaho]

6. No.

You are talking about the "last" "new" treatment involving Interferon, Ribavirin, and either Boceprevir or Telaprevir. Sovaldi can be combined with Olysio (another targeted anti-viral) for a twelve week treatment - minus Interferon and Ribavirin. This "new" "new" treatment is expensive but it's also virtually side effect free and the cure rate hovers around 95% for genotype 1 Hep C.

The real reason Sovaldi costs so much is two fold. First, greed and second, the presence of other treatments in the pipeline that will obsolete Sovaldi in two to three years.

[FarPoint]

8. I am familiar with Pegasys weekly injections over 6-9 months..

Combined with Ribavirin tablets twice a day typically. Within that series is a sub series of Incivek tablets taken 3 times a day with 20 grams of fat for 12 weeks...a most difficult challenge.. Compliance with schedule is essential. Clients need a strong support system to be encouraged to complete this course as its equivalent to the course of American Ninja Warrior. Most clients give up.

That all said... I completely agree with the insanity of cost of the medication. Secondly, I believe a the medical management aspect is weak....I think weekly nursing visits should be included to render ongoing troubleshooting of side effects. Typically a client is given literature, an hour of teaching and sent on their own...inadequate!

[Blue Idaho]

10. I was one of those patients.

Sadly that horrific drug combo didn't work for me and I know others who cleared the virus after 48 months of treatment but then had the virus re-surface months after treatment ended. The good news is - there are a number of new drug combos in the pipeline and being used in trials that exclude all of these drugs and promise a shorter, side effect free treatment with an extremely high degree if success.

The question for many Hep C patients now is - when to treat.

While I think the drug company has some questions to answer - the entire for-profit model needs to be looked at. How much profit is enough - when it comes to public health concerns.

[LeftyMom]

9. It depends on the version of the virus.

Some get a shorter pill-only regimen. What you're describing is the worst case scenario for duration and need for injections.

[GeorgeGist]

5. But US got plenty of money to kill thousands of people ...