Oregon Health Plan says no to unlimited access to pricey Hep C drugs


Taking advantage of a special waiver that allows it to deny routine coverage of drugs based on cost and efficacy, Oregon Health Plan intends to limit access to Gilead's (GILD) Sovaldi and J&J's (JNJ) Olysio. The combination therapy, which is becoming more and more popular among clinicians, costs $150,000 per regimen. Covering a third of the 7,000 OHP members with Hep C for Sovaldi alone ($84,000/regimen) would cost $196M. This would double its system-wide drug spending. Last year, the Plan spent a total of $377M for pharmaceuticals for all of its 600K members.

In 2012, Governor John Kitzhaber agreed to cap OHP costs in exchange for $1.9B in federal aid over five years. If costs rise above 3.4%/year it must reimburse the feds hundreds of millions of dollars.

The OHP situation is getting a lot of scrutiny because of the budget-busting consequences of paying for ultra-expensive drugs. Many observers hope its actions spur debate on how to curb prices without stifling innovation.

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Comments (28)
  • 13302632
    , contributor
    Comments (1772) | Send Message
     
    After Oct'14, the all oral non-interferon treatment will be out by Gilead and Olysio should not be necessary. That will drop the treatment by at least 1/3 I would expect plus reduce side effects. Phasing treatment is practical after that although it could be justified to finance the treatment for all in order to reduce future costs of chronic care by CURING all these 7000. Also, those 7000 would not be spreading the disease possibly avoiding future cases all together.

     

    I also expect some groups to get subsidized treatment, but I don't blame Gilead to not discount the drug too much before recovering development costs and some reward for their risk of capital. The "doubling" of system wide drug spending is very misleading as it will be a one time charge to CURE 7000, the drug spending will drop precipitously back the next year at the same time as chronic care costs drop because of the CURES. In other words the application of the CURE will pay dividends for years in reduced chronic costs and reduced cases of Hep C.
    12 Jun 2014, 09:45 AM Reply Like
  • MineMan
    , contributor
    Comments (557) | Send Message
     
    Are the patients being 'cured' by Sovaldi immunized from getting re-exposed to HEP-C? I understand that they may no longer pass HEP-C on. But, can they develope HEP-C from re-exposure to a bad needle?
    12 Jun 2014, 11:27 AM Reply Like
  • CassandraSees
    , contributor
    Comments (625) | Send Message
     
    Info on Hep - C risk factors:

     

    http://bit.ly/1iqVgKF
    12 Jun 2014, 11:38 AM Reply Like
  • 13302632
    , contributor
    Comments (1772) | Send Message
     
    I don't know the answer, but I suspect they could reacquire the disease. That is another reason to blanket cure everyone at once and largely eradicate the disease.
    12 Jun 2014, 12:11 PM Reply Like
  • goneskuba
    , contributor
    Comments (137) | Send Message
     
    How bout you cure the sickest, say 1000/yr and by 7-10yrs all will be cured in Oregon?!!
    12 Jun 2014, 11:57 PM Reply Like
  • goneskuba
    , contributor
    Comments (137) | Send Message
     
    Yes, reinfection is a very likely scenario if you were to restart using dirty needles, as well as others...but blood transfusions carry a very small percentage of those who could potentially still get it from there.

     

    You do know why the CDC has created guidelines for who should get screened...and if you received a blood transfusion prior to July 1992, your on that list!!!
    13 Jun 2014, 12:00 AM Reply Like
  • Snapcap
    , contributor
    Comments (191) | Send Message
     
    In my non expert opinion, I don't think all 7000 HCV sufferers in Oregon will need to be treated. Only those with severe medical needs will receive the regimen. Everyone seems to think that all 2.4 million infected with HCV need this treatment. I don't think that is the case. The few cases that I know about have all been severely ill, with liver transplant imminent, or post transplant where the disease has attacked the new liver. Most HCV infected will not need to be treated with this option.
    12 Jun 2014, 09:55 AM Reply Like
  • 13302632
    , contributor
    Comments (1772) | Send Message
     
    Hep C is insidious and even those that seem asymptomatic for years can end up with damaging affects of the chronic disease that eventually cause serious issues and serious health care costs. Eventually, I expect everyone to be treated, but it will happen in phases with as you said those most critical first. The cost of treatment will drop as competitors emerge, development costs are recovered, and the eventual generic versions arrive.

     

    Remember also that Hep C is transmissible, so every cure reduces the number that will acquire the disease.
    12 Jun 2014, 09:58 AM Reply Like
  • :-) ;-)
    , contributor
    Comments (541) | Send Message
     
    Not quite the case. The doctors in the clinics I've been to, generally think all patients should be treated. Up 'til now the treatment has been so difficult that they monitor and wait for something like elevated liver enzymes before starting treatment. When Gilead's combo drug is approved in Oct. and the treatment is no longer life altering, I expect that many people that would previously have waited, will be treated.

     

    I've heard that some people live their lives with the virus and are not affected by it, but if treatment is easy I think doctors will not be willing to bet on that outcome. I'm also not an expert, but I have been successfully treated with the combo drug. And I was involved with two different clinics over a period of three years, so I have some idea how the system works.
    12 Jun 2014, 11:40 AM Reply Like
  • MineMan
    , contributor
    Comments (557) | Send Message
     
    Some strains of HEP are much more viralent than others.
    13 Jun 2014, 10:00 AM Reply Like
  • :-) ;-)
    , contributor
    Comments (541) | Send Message
     
    Genotype 1, that I had, the most common and difficult to treat. It was specifically targeted in the trials and was successfully treated.
    13 Jun 2014, 12:24 PM Reply Like
  • gayle.edmondson@gmail.com
    , contributor
    Comments (15) | Send Message
     
    How much are Oregon hospitals going to pay for a new liver or are they just planning on letting their patients die? Already proven that the Sovaldi treatment is around 10% +or- the cost of conventional treatments of Hep C. Gilead is in my opinion put a very reasonable price on a drug that CURES Hep C. If I were living in Oregon, and I strongly considered it, I would want my providers to care or cure me rather than make a political statement. That said, I can't see how they can stick with this proposal, if they do so said for all the infected people living in Oregon.
    12 Jun 2014, 09:59 AM Reply Like
  • Moky
    , contributor
    Comment (1) | Send Message
     
    I have hep. C, I am on OHP and I have the feeling Family Care Insurance would be glad to let me die.
    11 Jul 2014, 08:33 PM Reply Like
  • SivBum
    , contributor
    Comments (2710) | Send Message
     
    Preventive care drugs should be covered if not free. But most are not because of users are not sick, yet and big Pharmaceuticals do not make money off healthy people.
    12 Jun 2014, 09:59 AM Reply Like
  • dieuwer
    , contributor
    Comments (2924) | Send Message
     
    OHP rather spends money on fat cat board-member bonuses than helping people suffering from HEP-C.

     

    That's what you get with "Big Healthcare"!
    12 Jun 2014, 10:12 AM Reply Like
  • SivBum
    , contributor
    Comments (2710) | Send Message
     
    dieuwer,

     

    Say, if you were suffering from HEP-C. You you take $150K cash instead of taking the $150K drug?
    12 Jun 2014, 10:21 AM Reply Like
  • dieuwer
    , contributor
    Comments (2924) | Send Message
     
    Nice try at a false dichotomy. Have any more fallacies in store?
    12 Jun 2014, 10:26 AM Reply Like
  • SivBum
    , contributor
    Comments (2710) | Send Message
     
    Not a dichotomy at all. ACA's spirit is to bring the hyper inflating healthcare cost to the front and center. We all must be aware of the cost of treatments, drugs, procedures and tests. You think the $150K per dosage is free? Someone has to pay for it.
    12 Jun 2014, 10:44 AM Reply Like
  • goneskuba
    , contributor
    Comments (137) | Send Message
     
    Not per dosage, but rather for full treatment through 12 weeks...thats once a day x 12 weeks!!!

     

    And again, the bears/shorts of this stock and the ignorant can still be wrong all the time!!!

     

    Sovaldi.....the drug made by GILD cost $84k while Olysio made by J&J covers the rest. This is again, of course, off label.

     

    Sovaldi and the NUC will level the playing field at costs, I think around < $100k. That will provide cures and strengthen heard immunity. You want Hep C? No...then let these ppl get treated and you have a lesser chance of getting infected. What do you think are your lifetime chances of needing a blood transfusion???
    13 Jun 2014, 12:05 AM Reply Like
  • SivBum
    , contributor
    Comments (2710) | Send Message
     
    Stand corrected...hope competition would bring down the price gouging:

     

    AbbVie HCV regimen gets priority review

     

    The FDA grants AbbVie's (ABBV +0.9%) three-drug HCV regimen priority review. The company submitted its NDA on April 21, 2014.
    The antiviral interferon-free fixed-dose combination consists of ABT-450 (ritonavir) co-formulated with ABT-267 (ombitasvir) and ABT-333 (dasabuvir) with or without ribavarin. ABT-450 was co-developed with Enanta Pharmaceuticals (ENTA).
    In May 2014 ABBV submitted its marketing authorization applications to the EMA for regulatory approval in the EU.
    13 Jun 2014, 04:05 PM Reply Like
  • Snapcap
    , contributor
    Comments (191) | Send Message
     
    13302632, You are correct re the process. And the rest of you must remember that we are talking about the Oregon Health Plan, which is the taxpayer funded state health care provider. Most private insurers are providing coverage on an "as needed" basis. I don't think anyone with insurance has been refused access to this treatment. Don't forget that the doctors will determine who is most in need, and act accordingly.
    12 Jun 2014, 10:30 AM Reply Like
  • 13302632
    , contributor
    Comments (1772) | Send Message
     
    Considering pharma costs have dropped as a percentage of overall health care for the last decade, when pharma produces a cure I think it is very reasonable for that ratio to change somewhat. Curing 20% a year for 5 years certainly would not break the bank and would be one way to spread out the costs. I still think it would be better to do a one time special financing to cure everyone in sight once the non-interferon treatment is available.
    12 Jun 2014, 10:55 AM Reply Like
  • derrickthms182
    , contributor
    Comments (658) | Send Message
     
    Where has all the money gone? Oh yeah to the politicians, lawyers and insurance companies. Obamacare will probably help.
    13 Jun 2014, 11:43 AM Reply Like
  • CassandraSees
    , contributor
    Comments (625) | Send Message
     
    And the death panels rear their ugly heads....
    12 Jun 2014, 10:58 AM Reply Like
  • MineMan
    , contributor
    Comments (557) | Send Message
     
    Exactly what I was tyhinking. The scare tactics of the GOP against ACA rearing thier ugly head. Surprisingly, now from the people that opposed "death panels" in the past. Austerity isn't always the answer.
    12 Jun 2014, 11:32 AM Reply Like
  • :-) ;-)
    , contributor
    Comments (541) | Send Message
     
    MineMan, you said something I can agree with. Austerity often is fool's gold.
    12 Jul 2014, 11:45 AM Reply Like
  • ValueQuest55
    , contributor
    Comments (48) | Send Message
     
    Commercial insurance and political arrangements for health care may not be sustainable if current structures do not anticipate progress in medical science and actual cures, which do cost more to develop. Is the eradication of disease worth the disruption to business as usual? That's a value judgement, and the press has shared the opinions of the self-interested.
    12 Jun 2014, 12:24 PM Reply Like
  • GrowthGeek
    , contributor
    Comments (2750) | Send Message
     
    Remember the old Fram oil filter ad--"you can pay me now or you can pay me later." This is a short sighted political decision that will change as the alleviation of suffering and a true cure saves a lot--including money.
    8 Jul 2014, 11:56 AM Reply Like
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