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Payers rebel against Gilead over cost of hepatitis C pill

  • Insurers, patients and other payers are pushing back against what they believes is the exorbitant fee that Gilead (GILD) is charging for its new hepatitis C drug Sovaldi.
  • Previously: Pfizer lung-cancer drug fails in two Phase III studies
  • The pill costs $1,000 a pop, or $84,000 for a 12-week treatment vs $66,000 for the current standard of care.
  • The likes of Express Scripts (ESRX), Catamaran (CTRX), Aetna (AET) and CVS Caremark (CVS) are among those who are looking to pit similar treatments against each other, declining to provide coverage for some, and refusing to pay a premium based on one therapy being more convenient than another.
This was corrected on 01/27/2014 at 07:51 AM.
Comments (15)
  • Doug Miller
    , contributor
    Comments (44) | Send Message
     
    In reading the article linked to in "pushing back", it seems to me the Hep C activists are protesting against the wrong villians. Gilead has risked much to bring this drug to market. Aren't they the heros here? The PBMs like Express Scripts are just trying to protect their lush profits at the expense of their patients. If I were a Hep C patient, I think I would take a look at suing them if they tried to force me through an interferon regime before agreeing to pay for the far superior treatment. (I own shares of Gilead, Express Scripts and Catamaran. Express Scripts is the PBM in my own health plan. As an Express Scripts shareholder, I would like to see them prosper. But as a member of their health plan I'm not very happy to think they might deny me access to the best treatment in order to protect their very nice profits)
    27 Jan, 08:15 AM Reply Like
  • pemarangshar
    , contributor
    Comments (13) | Send Message
     
    Anyone pushing interferon is morally suspect - from a survivor viewpoint.

     

    ......... more to the point is short interest that trys to live at GILD
    27 Jan, 08:20 AM Reply Like
  • Deja Vu
    , contributor
    Comments (1153) | Send Message
     
    If you think the price for the drug the discovered, tested, got through the approval process is too much, simply don't take it.
    27 Jan, 08:24 AM Reply Like
  • MySharrona
    , contributor
    Comment (1) | Send Message
     
    Deja Vu, you obviously don't have Hep C. We have no choice. I failed on
    interferon and I have been waiting for these new drugs. Our insurance provider
    has no right to simply not provide us with some coverage, it will be life saving
    for many of us.
    28 Jan, 11:19 AM Reply Like
  • QuiteSavvy
    , contributor
    Comments (13) | Send Message
     
    $66,000 used to compare to the cost of other drugs by the carriers merely represents the cost of the medications and does not reflect the cost of administration (interferon requires administration intravenously in a medical facility which produces additional signficiant charges) and does not reflect the average cost of treating side effects and complications.. Bottom line: NET NET: GILD treatment and $84,000 represents a significant cost reduction, is better tolerated by patients and yes is far more convenient
    27 Jan, 08:27 AM Reply Like
  • PlatinumChip
    , contributor
    Comments (104) | Send Message
     
    When insurance companies lose the game of cash roulette with you they try to deny coverage, nothing new to see here. If they give you Interferon when it turns out you needed Sovaldi they could end up paying for both treatments. This is not a fight, Gilead and drug companies are the winner and we're just watching insurance companies writhe.
    27 Jan, 09:35 AM Reply Like
  • DAVE22Q
    , contributor
    Comments (217) | Send Message
     
    article did its job. pushing old news with new innuendo has pushed GILD down in early trading.
    27 Jan, 09:39 AM Reply Like
  • bjk413
    , contributor
    Comments (14) | Send Message
     
    PBMs have been doing this for a long time with the different tiers in formularies. This is recycling ESRX's comments from awhile back, even though the company later came out and said it was not specifically about HCV.

     

    Nothing new here expect the protesters don't know who to protest. Sad they are arguing for the side of the PBMs that don't seem to have their best interest in mind....
    27 Jan, 11:13 AM Reply Like
  • LSYMD
    , contributor
    Comments (71) | Send Message
     
    My research definitely is in contradistinction to the tone of the article. I believe that many scripts are being written and fulfilled. I would expect Medicaid reimbursement to be slower than that of private pay. However, one must realize that for the past 10 years (except 2013, when patients were being warehoused), 100,000 Hepatitis C patients were being treated annually in the US, at a per patient cost of $40000 to $90000, depending on the inclusion of a PI. The cure rate with these regimens was 50-70%, and there did not appear to be reimbursement concerns. The new all-oral regimens have a 95% cure rate with fewer side effects and a greater ease of administration. Therefore, the total cost to treat a patient, taking into account the high cost of complications from failed Hepatitis C therapy, is lower. I continue to project Gilead's Hepatitis C drug revenues at $8 billion for 2014, though recent prescription trends could make this high end estimate conservative. Although Hepatitis C therapy is the current driver of Gilead's growth, the company has an impressive pipeline in other areas, including oncology and fibrosis. Separately, I would expect ESRX to benefit financially from fulfilling Hepatitis C scripts via mail order, although its clients may be upset by the specialty pharmaceutical cost growth. Len
    27 Jan, 11:14 AM Reply Like
  • johnch789
    , contributor
    Comments (41) | Send Message
     
    66,000 for subpar results.... I am HCV educator and counseled hundreds through the incredible injectables ... some did well and others NOT at all , very inconsistent results and very low rates for genotype 1a , 1b etc... 84,000 to avoid larger patient costs down the road is not so bad .... thus far results are amazing ....I imagine the 84,000 is the high ball number and something a but less will result ... psych game in some ways. But they risked much to develop this drug as did Abbivie .....as others point out the side effects are expected to be way less so the patient may be more willing to move thru the tx and be more compliant ... ......
    27 Jan, 03:01 PM Reply Like
  • PEMINC
    , contributor
    Comments (114) | Send Message
     
    The costs are not exorbitant but the market demand may well be. Candidly, I suspect the alternate take-away is that these PBMs are seeing HUGE demand for Solvadi - and they can't do much else but belly ache and fence with Users and GILD.. to stretch out the demand.

     

    LSYMD is right on. At the end of the day its the all-in therapeutic costs and alternatives that count. And that includes patients that drop-out due to interferon side-effects and null effects by genotype. Solvadi is much faster, safer and more effective than anything else out there. So, insurance companies would rather policy holders get liver failure or liver cancer? How does that save 'em money?

     

    This is a miracle drug. I have an old friend that refused interferon for 20+ years, but got enrolled in the 7977 study. The viral count dropped massively and disappeared in a short time, with no - repeat NO - side effects. Compare that to interferon. Really, this is just insurance company hysteria that the sky is falling.
    27 Jan, 06:14 PM Reply Like
  • User 13440862
    , contributor
    Comment (1) | Send Message
     
    I have read all the comments and I noticed that nobody has said anything about some patient will have to still take interferon and Ribaviran and Sovaldi. That means the cost will be higher than the $84,000. I also agree with everybody that if the patient needs the drug then they should make sure the patient gets it and not worry about the cost.
    27 Jan, 07:39 PM Reply Like
  • khooker22
    , contributor
    Comments (3) | Send Message
     
    I am a liver transplant patient who has been cured of Hep C by the Gilead drug therapy after the virus returned post transplant. The cost to my insurance company for the transplant and treatment is nearly $500,000 after several complications from the operation. Had the Gilead drug therapy been available in the 90's when Interferon and Rebavirin treatment failed to stop the virus, I would have never needed a transplant. That translates into savings of $416.000 for the insurance companies and years of my suffering, not to mention lost wages from time off, etc. With out the Gilead treatment now, it is inevitable I would need another transplant within 10 years or expensive hospital stays until my early demise, as the virus had begun to attack my new liver with a vengeance. I am LIVING proof that an ounce of prevention is worth a pound of cure!
    27 Jan, 07:39 PM Reply Like
  • dmarcucci
    , contributor
    Comments (2) | Send Message
     
    I am retired and 67 years old. I was diagnosed with HCV in 1998. Since then I have gone through four drug studies and HCV therapies. However none of these treatments produced a cure. In 1998 the first therapy I was on had only a 18% cure rate. I run a HCV support group.

     

    I find this entire conversation very interesting and tragic. We have been trying to find a cure for HCV since it was identified in the early 1990's. Since then tens of thousands of patients, drug companies, herpetologists have been searching for the Holy Grail of the cure. Now that we may have circled in on a probable cure we have all this chatter coming from the self proclaimed insurance advocates and health cost advocates we start to get push back. I question the motives pushing this sudden concern.

     

    I was diagnosed with HCV genotype 1a in 1998. I was devastated and thought it was a death sentence. Fortunately I found I t was not. I joined a support group and found there was alternatives and drug companies were working to find cure. Impressive progress has been made to date the latest is the Gilead regime. I have been through four treatments including interferon, ribavirin and various specialty drugs from Roech, Amgen, and the Merck. I challenge anyone to go through HCV treatment that includes Interferon for 48 weeks and have a less than 50% chance of a cure.

     

    Now that there is a possible cure for HCV with a 90% plus chance of a cure with minimal side effects and there is a chorus of Nay-Sayers because of the cost. I would invite any of those individuals to go on HCV therapy with interferon for 48 weeks and see what they think after completing it. Some of the more prominent side affects are insomnia, brain fog, skin rash, vomiting, weight loss to name a few.

     

    Dennis
    28 Jan, 12:49 AM Reply Like
  • dmarcucci
    , contributor
    Comments (2) | Send Message
     
    I find this entire conversation very interesting and tragic. We have been trying to find a cure for HCV since it was identified in the early 1990's. Since then tens of thousands of patients, drug companies, herpetologists have been searching for the Holy Grail of the cure. Now that we may have circled in on a probable cure we have all this chatter coming from the self proclaimed insurance advocates and health cost advocates we start to get push back. I question the motives pushing this sudden concern.

     

    I was diagnosed with HCV genotype 1a in 1998. I was devastated and thought it was a death sentence. Fortunately I found I t was not. I joined a support group and found there was alternatives and drug companies were working to find cure. Impressive progress has been made to date the latest is the Gilead regime. I have been through four treatments including interferon, ribavirin and various specialty drugs from Roech, Amgen, and the Merck. I challenge anyone to go through HCV treatment that includes Interferon for 48 weeks and have a less than 50% chance of a cure.

     

    Now that there is a possible cure for HCV with a 90% plus chance of a cure with minimal side effects and there is a chorus of Nay-Sayers because of the cost. I would invite any of those individuals to go on HCV therapy with interferon for 48 weeks and see what they think after completing it. Some of the more prominent side affects are insomnia, brain fog, skin rash, vomiting, weight loss to name a few.

     

    Dennis
    28 Jan, 12:50 AM Reply Like
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