State Medicaids feeling the pinch from Sovaldi


An analysis by Express Scripts (ESRX +0.1%) shows the enormous potential costs confronting state Medicaid programs of paying for Gilead's (GILD +1.1%) HCV treatment Sovaldi. The $84,000 full regimen tab will put substantial budgetary pressure on many states like CA ($6.8B), TX ($5.4B) and FL (3.8B) if every HCV sufferer is treated.

Express Scripts estimates that more than 750K Medicaid patients have chronic HCV infections (total cost to treat with Sovaldi + ribavirin or Olysio (JNJ -0.5%) = ~$55B).

Despite Gilead's assertions that Sovaldi actually saves money by curing HCV and avoiding the costs of liver failure, Congress has launched an investigation into its pricing rationale. The company's previously announced plan to sell Sovaldi to Egypt for $900 potentially complicates its position.

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Comments (126)
  • Jack Hutchison
    , contributor
    Comments (520) | Send Message
     
    Some grandstanding leftist pols want to know why the cure for HCV is worth its weight in Solvadi, a drug priced according to value. What these clueless congressional clowns don't realize is the savings from long term alternative treatment and/or liver transplants.
    17 Jul 2014, 11:15 AM Reply Like
  • Rope a Dope
    , contributor
    Comments (706) | Send Message
     
    I am as far to the right as you can get and I also would like to know why Americans have to pay $84,000 while non-Americans get this drug for $900.
    17 Jul 2014, 11:28 AM Reply Like
  • canb888
    , contributor
    Comments (618) | Send Message
     
    A doctor's consultation costed me $350 by a US doctor practicing in Beijing while a similar 30 minutes consultation in a government owned Hospital in China by a well trained trained doctor costed me less than $3. I know the difference is not due to quality because I was in the medical industry and I knew the topic of the consultations which was about blood pressure and I could also compare quality of the advice given. Let's see, 3:350 ratio vs. 900:84000 = 9:840 = 3:280. Go Gilead (but don't sell it for $900 anywhere).
    17 Jul 2014, 12:04 PM Reply Like
  • getrichslowly
    , contributor
    Comment (1) | Send Message
     
    Has anyone done a cost benefit analysis of using Solvadi versus the cost of other treatrments long term?
    17 Jul 2014, 12:23 PM Reply Like
  • moksha22
    , contributor
    Comments (54) | Send Message
     
    Share the wealth.
    17 Jul 2014, 12:47 PM Reply Like
  • Rasna
    , contributor
    Comments (104) | Send Message
     
    I've seen a number of them, GRS. There is no way that the that any current regime comes close to Solvaldi. I hate these kind of articles because, as we've seen in the past, ExpressScripts, has it's own business model/agenda to promote that is not at all concerned with the cost of medications or the well being of patients or the public.

     

    In addition, I can almost guarantee that the idiots in Congress who are ranting about the cost of the Solvaldi treatment HAVE NOT done, nor have they seen, a cost benefit analysis, efficacy analysis or quality of life analysis that would help them put forward more intelligent and informed opinions. For them, it's all politics, all the time, facts be damned.
    17 Jul 2014, 01:02 PM Reply Like
  • jsijimmy
    , contributor
    Comments (556) | Send Message
     
    What do iphones sell for in Egypt?
    18 Jul 2014, 12:27 AM Reply Like
  • 13302632
    , contributor
    Comments (1772) | Send Message
     
    I'll just provide a link since this is 3rd time I've commented on it. Gist is Egypt is special case with 15% infection rate due to a vaccination campaign that reused needles decades ago. That and a low per capita income were humanitarian/business decision to try to help Egypt.
    http://bit.ly/WiVleX
    18 Jul 2014, 03:44 PM Reply Like
  • alan ljl
    , contributor
    Comments (271) | Send Message
     
    The Alert title is inflammatory and old news.
    The bullet points are also non value added information of media points the are not of alert nature.
    Where are the world wide cure's positive benefits mentioned, the liver transplant and lifetime rejection meds costs that would be needed if Gilead's cure was not available.
    17 Jul 2014, 11:19 AM Reply Like
  • Rasna
    , contributor
    Comments (104) | Send Message
     
    I agree Alan. See my previous comment. Either the writer is simply uninformed, is trying, unsuccessfully, to be provocative, or is a shill/troll for ExpressScripts.
    17 Jul 2014, 02:18 PM Reply Like
  • jarhead999
    , contributor
    Comments (79) | Send Message
     
    Sovaldi a solid winner for Gilead regardless of price reduction, LOOK at margins.. combo pill due in late Nov.. pipeline sound...hum looks good to this ole put writer, have $55, $62.50, $65, $70's... good as gold...no, actually better ha...
    17 Jul 2014, 11:32 AM Reply Like
  • zorro2828
    , contributor
    Comments (740) | Send Message
     
    This is simply spam.. all of this has been addressed in multiple articles... go ahead and sell and buy options to sell sell sell.. just wait to next week when the doors fly off and GILD explodes up to par! NONSENSE ARTICLE ... Again, if you do not like the price, do not buy the drug...
    17 Jul 2014, 11:48 AM Reply Like
  • Chris Deahl
    , contributor
    Comments (63) | Send Message
     
    This Sovaldi pricing controversy is ripe for some kind of conspiracy theory. Perhaps it could involve Gilead's campaign contributions or Obama's affection for Egyptians. Am I late on this?
    17 Jul 2014, 12:05 PM Reply Like
  • :-) ;-)
    , contributor
    Comments (540) | Send Message
     
    There were flashing lights over San Francisco that did not appear on radar. My bro-in-law witnessed helicopter flights into Gilead's complex. He thinks they were (gasp) black helicopters. SShhhhh this is all hush hush.
    17 Jul 2014, 12:54 PM Reply Like
  • CSYJ
    , contributor
    Comments (3859) | Send Message
     
    Um :-) ;-),

     

    SFO airport is south of San Francisco. Foster City (Gilead complex) is south of SFO! So what were those helicopters doing by flying north from SFO?
    19 Jul 2014, 01:26 AM Reply Like
  • :-) ;-)
    , contributor
    Comments (540) | Send Message
     
    That just makes it more mysterious. (C'mon, can't you play along?)
    19 Jul 2014, 11:27 AM Reply Like
  • tarheelboy
    , contributor
    Comments (333) | Send Message
     
    Two things: the cost of sovaldi, considering its results and regimen, is no more expensive than many other high priced drugs that do not get near the results. Also, GILD paid over $11 billion outright for the drug and took all the risk. And thirdly, congress has no business whatsoever sticking its smelly noses into this market place. Why don't they spend the time getting 80% of these free loaders off Medicaid!!!!!!!!
    17 Jul 2014, 12:08 PM Reply Like
  • Doug Miller
    , contributor
    Comments (91) | Send Message
     
    The "analysis" by Express Scripts is either deliberately misleading, or was prepared by an incompetent staff member.

     

    1.) It uses the "list" price of the drug to estimate the cost
    2.) Allows nothing for the cost savings for ceasing chronic treatment for those cured and the substantial reduction of new cases to be treated. After a few years of Sovaldi, treatment costs for chronic Hep C would virtually disappear. Seems like a huge long term cost savings.
    3.) Assumes all patients would get treated in one year. Spread those costs over, say 5 years to treat all patients, and they don't look near so daunting.
    4.) Does not account for the added burden to welfare programs of supporting people too sick to work due to Hep C. (Housing, disability, food stamps, aid to dependents, etc.). These cost will largely evaporate.
    17 Jul 2014, 12:12 PM Reply Like
  • DoctoRx
    , contributor
    Comments (7048) | Send Message
     
    Well said, Doug (and many other commenters here). Medicaid always gets discounts. And treatment can be spread out over many years, depending on what stage of disease the patient has and what the facts come to show about the reasonableness of delaying treatment when there is no obvious liver damage. One thing to consider, though, is that intravenous drug users who are at high risk of getting hep C again even after being cured pose a real conundrum for payors. There are real issues here. I'm sure Gilead is intensively discussing them with payors as well of course with physicians.
    17 Jul 2014, 06:46 PM Reply Like
  • Fatalorian
    , contributor
    Comment (1) | Send Message
     
    Spot on with your first point. Medicaid receives a minimum statutory discount of 23.1% off Average Manufacturer's Price (NYSE:AMP). If GILD has taken price actions, there could be a CPIU penalty component added on top of the 23.1%.

     

    Not to get into the specifics of the AMP calculation here, but it is generally at least 2-3% discounted against the list price.

     

    So we're looking at around a minimum discount to Medicaid of ~25% or $21,000.
    21 Jul 2014, 01:22 PM Reply Like
  • Trying2StayFocused
    , contributor
    Comments (106) | Send Message
     
    The 'analysis' by ESRX can also be taken to illustrate the enormity of this miracle medical breakthrough. So many potential patients benefiting.

     

    Funny, it seems they used to complain about the costs of orphan drugs…..

     

    Jackasses!
    17 Jul 2014, 12:15 PM Reply Like
  • ngmissaq@aol.com
    , contributor
    Comment (1) | Send Message
     
    It's virtually a cure. What more can anyone ask for? Gilead has done amazing things.
    Think of all the drugs that fail after millions have been spent on their development.
    17 Jul 2014, 12:19 PM Reply Like
  • aladden520@aol.com
    , contributor
    Comments (2) | Send Message
     
    I agree. I would also like to pose some questions. How many diseases has Congress or any insurance company developed a cure for? Even if they could, would they be willing to jump through all the hoops and spend the vast sums of money that the pharmaceutical industry in general does to bring a drug to market? Finally, why do we pay the elected officials on both sides including the president for doing a less than adequate job? The answers to the above are none, probably not, and there is no good reason. We as a society will make millionaires out of athletes and actors who don't really contribute that much to mankind. I think that companies like Gilead who employ many people and do really great work should make the profits they need to continue their endeavors.
    17 Jul 2014, 06:43 PM Reply Like
  • JohnBinTN
    , contributor
    Comments (4342) | Send Message
     
    Maybe the world's governments (collectively) should purchase the patent and rights from Gilead for Sovaldi... They care about their people or they don't. I'm okay with w/e they want to sell their invention/discovery for. It is kinda sour grapes of them to put the screws to Americans, but that's all it amounts to - sour grapes. It's theirs, afterall.
    17 Jul 2014, 06:49 PM Reply Like
  • :-) ;-)
    , contributor
    Comments (540) | Send Message
     
    It IS a cure. And it's EASY, few if any side effects. This will all be blindingly apparent in Oct. I think/hope that much of this controversy disappears at that point.
    17 Jul 2014, 09:19 PM Reply Like
  • Brush
    , contributor
    Comment (1) | Send Message
     
    Why stop with Sovaldi? Investigate all therapies that sell abroad for handsome discounts.
    17 Jul 2014, 12:20 PM Reply Like
  • moksha22
    , contributor
    Comments (54) | Send Message
     
    I thought there was a free market place in the USA without socialist government intervention...
    17 Jul 2014, 12:50 PM Reply Like
  • brthesac
    , contributor
    Comments (113) | Send Message
     
    Sovaldi stops many patients from dying. I wonder what that is worth.
    17 Jul 2014, 01:29 PM Reply Like
  • hi5757
    , contributor
    Comments (13) | Send Message
     
    Absolute nonsense, the old standard of care for hep C was a nightmare. All the rescue drugs that needed to be taken just to get thru it in most cases cost a fortune let alone only having a 30-40% cure rate. And then theres the fact that so many people that suffered with permanent damage after treatment and will need meds to cope, in some cases for life.

     

    I have HCV and have been praying, waiting, and hoping for a drug like this to come along. I have been involved in many support groups and know first hand the problems that occurred with the old treatments, and it was usually, in most cases, a year of Hell. $84,000 is alot of money but just the tip of the iceburg compared to the cost of not treating and dealing with all the health issues HCV can cause.
    17 Jul 2014, 01:30 PM Reply Like
  • jsijimmy
    , contributor
    Comments (556) | Send Message
     
    This all can be handled pretty easily - when the GILD reps go to congress with all the papers that were "asked" for, they should do the following:
    1) turn in the 'papers'
    2) Give the congressmen/women the following scenario: a) Your son/daughter (who has a family) has been diagnosed with HCV - you can (1) take 8-12 week treatment of Solvaldi for $84,000 (with a discount for whatever drug plan you are in), or (2) you can choose to get a liver transplant ($300-$500K) and all the associated drugs ($$$???) that go along with that procedure and take rejection meds ($$$???) for the rest of your life......."..Having said that Mr./Mrs. congressman/woman or Mr./Mrs. Senator - which scenario would you choose for your son/daughter?"

     

    And, leave it at that....
    17 Jul 2014, 09:00 PM Reply Like
  • floody
    , contributor
    Comments (17) | Send Message
     
    In a formal press release, Gilead should thank the congressman for their inquiry and opportunity to perform a cost comparison analysis. Then, line item by line item, they should include all the direct and indirect costs of both treatments. Gilead's conclusions will embarrass the congressman. Within days, their silly and childish grandstanding will fade away. That is how you embarrass the uninformed.
    17 Jul 2014, 11:20 PM Reply Like
  • 13302632
    , contributor
    Comments (1772) | Send Message
     
    You are wrong. "The border is secure" Harry Reid would still say black is white. Truth, justice, fairness, means nothing to politicians. Power, money, and what their lobbyists want mean everything. And they are used to their sheeple followers swallowing every jingoistic line (and bald face lie) they deliver.
    18 Jul 2014, 03:57 PM Reply Like
  • :-) ;-)
    , contributor
    Comments (540) | Send Message
     
    Really? "sheeple"? That puts you in an elite crowd led by Sarah Palin and Glen Beck. They represent the most empty-headed racist contingent of the sad old GOP.
    21 Jul 2014, 09:46 AM Reply Like
  • Rope a Dope
    , contributor
    Comments (706) | Send Message
     
    floody, $84,000 in the US compared to $900 in Egypt and you believe a Congressman will be embarrassed?

     

    I would like to know why Americans are subsidizing R&D costs for the rest of the planet.
    21 Jul 2014, 09:56 AM Reply Like
  • derrickthms182
    , contributor
    Comments (653) | Send Message
     
    Why so serious? Empty headed and racist? Not the race card again. Sounds like an Obama voter. Congrats on two victories and Obamacare with the website.
    21 Jul 2014, 10:25 AM Reply Like
  • 13302632
    , contributor
    Comments (1772) | Send Message
     
    :-) Do you believe the border is secure? I used Harry Reid as an example just because that was the most straightforwardly absurd lie told directly to the American people in the last few days. I wasn't intentionally singling out either party, because both are full of low information voters, and in fact I am independent and reject both the mainstream parties. But your knee jerk response is telling (about yourself). And I love the connection with anyone concerned with border security is racist. Just as much if not more bigotry comes from the left than the right. The tea party has been smeared with that label and the irony is those smearing are more guilty than the tea party. Let's agree bigots and racists exist and then move on to actually debate issues.
    22 Jul 2014, 10:39 AM Reply Like
  • 13302632
    , contributor
    Comments (1772) | Send Message
     
    Do 5 minutes of research and see if you can come up with a reason why Egypt is getting big discount. Hint: they are very poor(25x less per capita income) and and have 15x our infection rate (15%) because of a vaccination program gone bad decades ago (reused needles). So that $900 is like 25K to us, so their total country burden is like 5 times ours in relative terms even with $900 cost. So many folk are seizing on this one huge discount that makes so much sense if you have any humanity at all, because they haven't taken even 5 minutes to actually inform themselves.
    22 Jul 2014, 10:46 AM Reply Like
  • Rope a Dope
    , contributor
    Comments (706) | Send Message
     
    If they are so poor, they should not reproduce.
    22 Jul 2014, 01:04 PM Reply Like
  • derrickthms182
    , contributor
    Comments (653) | Send Message
     
    The answer is capitalism. Gilead knows no one can afford $84000 in Egypt so they sell for discounted price to make whatever profit they can. Since they have exclusive rights any profit is profit no matter who it is sold to. If you don't sell anything then no profit is made. They could make the price $1,000,000 but no profit would be made.
    22 Jul 2014, 01:55 PM Reply Like
  • CSYJ
    , contributor
    Comments (3859) | Send Message
     
    Let's see, $84,000 divided by 25 is $3,360. Higher infection rate is their problem. US is giving them so much in military aid already every year. A fair and "humane" price ought to be no less than $3,000.
    22 Jul 2014, 05:20 PM Reply Like
  • Capt Mogul
    , contributor
    Comments (27) | Send Message
     
    Rope
    The answer is, the lawyer ratio in Egypt
    18 Jul 2014, 07:21 AM Reply Like
  • Trying2StayFocused
    , contributor
    Comments (106) | Send Message
     
    In 2012, Egypt is reported to have received $1,404,000,000 in Foreign Aid.

     

    http://bit.ly/poVHLB

     

    Maybe we should hold a hearing or something.
    18 Jul 2014, 09:56 AM Reply Like
  • Chazuu
    , contributor
    Comments (263) | Send Message
     
    When the Salk vaccine for polio was developed there was a national campaign to distribute it to everybody. I believe that it was free to the public (or low cost). I remember going with my children and wife to the local fire station to receive it. Because of this national public health effort the deadly disease was effectively eliminated from the United States.
    The entire Salk vaccine immunization was about saving lives. The current developments in drugs seem to be about making money. What has gone wrong?
    18 Jul 2014, 10:09 AM Reply Like
  • Trying2StayFocused
    , contributor
    Comments (106) | Send Message
     
    Chazu,

     

    Surely it is not your position that public health/healthcare was better in the 40's and 50's?

     

    If it is all about 'making money,' why would Gilead be interested in Egypt at all?

     

    Perhaps you did not mean to impugn the folks behind this breakthrough. But, then again, perhaps that is exactly your intent.

     

    Taken as a whole, I find your comment somewhat disturbing.
    18 Jul 2014, 10:46 AM Reply Like
  • JohnBinTN
    , contributor
    Comments (4342) | Send Message
     
    It was, in the desire to eradicate polio... They could do the same for Hep C, but don't seem to care as much... Perhaps if a prez was affected by it, that attitude would change.
    18 Jul 2014, 10:52 AM Reply Like
  • 13302632
    , contributor
    Comments (1772) | Send Message
     
    Salk investigated patenting it, but according to the patent laws of the time it couldn't be done (natural disease and cure). I also don't think Salk spent 10 years getting it through the FDA and 12B+.
    18 Jul 2014, 03:41 PM Reply Like
  • aladden520@aol.com
    , contributor
    Comments (2) | Send Message
     
    Chaz, nothing is free including healthcare. You have control over your treatment when receiving healthcare. Don't buy a treatment if don't like the price. Seek an alternative. In another Seeking Alpha article I read that the very first Sovaldi pill cost Gilead 11 billion to develop. They have to be able to pay their employees and make a profit. Nobody works for free even in healthcare. It is very much a business just like wherever you work.
    19 Jul 2014, 11:53 AM Reply Like
  • Chazuu
    , contributor
    Comments (263) | Send Message
     
    I am not saying that public health or health care was better in the 50s. It is the attitude that was better. The campaign to eradicate polio was not based on how much money it would make for somebody. It was based on curing a significant health problem.
    The cure for Hep C is a great break through. Neither our government nor some of the commentators on this site seem to be as interested in the cure as in the ability of Giliad to make a lot of money.
    19 Jul 2014, 11:38 AM Reply Like
  • Trying2StayFocused
    , contributor
    Comments (106) | Send Message
     
    They are one and the same, Chaz, one and the same.
    23 Jul 2014, 09:18 AM Reply Like
  • Chazuu
    , contributor
    Comments (263) | Send Message
     
    aladden520@aol.com
    There are 3,200,00 individuals in the U.S. alone suffering from Hep C. (according to Newsweek), If it cost $11,000,000 to develop this drug, the cost per patient would only be $3,438 if administered to all patients.
    On the other hand if all 3,400,000 U. S. patients paid $84,000 each for treatment Gilead would recover $200,000,000. (A little over 18 times their cost)
    Why couldn't they sell to Egypt or elsewhere at a fraction of the cost?
    Who do you think pays the bill for these drugs? You do. So do I. It will be factored into the cost of our medical insurance, whether our insurance is private or government. In either case we pay this outlandish bill. We US citizens will pay it and Egypt, India and Europe to a lesser extent are getting a free ride!
    19 Jul 2014, 02:46 PM Reply Like
  • jsijimmy
    , contributor
    Comments (556) | Send Message
     
    Chaz - if we're going down the route you stated, how about this?

     

    Assuming all your numbers are correct, then $11,000,000,000 x 300% profit (standard for any American manufacturer of anything) = $33,000,000,000. And, that result divided by 3,200,000 = $10,312.5 per person. So, no liver transplants required (@ $500K each), no rejection meds needed (?$$$/year for the rest of their lives).... that's just for the US...rest of the world pays the same price (+ or - country discount).

     

    What do you think???
    20 Jul 2014, 04:11 PM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    There are over 150 million men, women and children living with hepatitis C worldwide. This is a public health issue that could be discussed on the basis of eradicating a dangerous infection. Instead, the pricing by Gilead is absurd and the market is refusing to bear it. To treat people in place like Europe (and a second drug is necessary) would wipe out health care systems in places like France, where they have a "discount." Gilead did NOT have R&D costs either--they bought the drug company, Pharmasset for $11 billion. That's not R&D--that's a boneheaded business decision to pay that much when it maybe costs $250 million to bring a drug to market (and Pharmasset basically had only 3 drugs in its portfolio).

     

    This means millions will not receive the treatment, other infections will not get treated, Medicaid and insurance formularies could be crippled--there is NO justification for this or for the vicious attack on people living with chronic diseases by companies that are out-of-control. It may give some investors a little hard on, but ultimately, this isn't a sustainable model for innovation. Holding people's lives ransom to such pricing, debilitating health care systems and blocking people out altogether results in enormous suffering and death. And in FACT, many of the studies done to assess the clinical efficacy in various populations were done by the NIH, i.e., publicly funded. We need MORE of that--because innovation has been stymied by the silos of knowledge, the lack of interest in infectious diseases and outrageous licensing fees all along the discovery process that impede innovation.

     

    For those of you who cavalierly care only about the bottom line, your greed is what propels and feeds this failed and demonstrably failing system. Even as discovery pipelines fail, and pharma companies seek ever more innovative ways to screw people worldwide.
    20 Jul 2014, 03:26 PM Reply Like
  • 13302632
    , contributor
    Comments (1772) | Send Message
     
    Let me ask a simple question. Is the world better off before or after Gilead produced and marketed Sovaldi? How much total money has been invested in the pursuit of a cure for Hep C (BY ALL THE PHARMA COMPANIES)? How many years have they invested that money? What has been the total cost of capital and risk of capital? In a socialist system, we would not be having this debate now, because there would have been little incentive to invest the vast sums. It would be a decade or 2 down the line when the cost to produce such medicines is made cheaper by (much slower) advancing technologies. How many lives will be saved(at any cost) because (greedy!) people risked in order to accelerate the finding of a cure? Probably in a time frame later than Gilead Sovaldi will be made generic some socialist system would have produced the first instance of the drug. What you don't seem to understand is that you are lucky to get Sovaldi AT ANY PRICE. It is only available because thousands upon thousands of dedicated CAPITALIST workers inside of a CAPITALIST corporations worked tirelessly and at great personal sacrifice, with financial reward being a big factor for all those who are invested (shareholders, and corporate workers alike).

     

    First, there is no expectation that the retail price is going to be paid by everyone. So, it is disingenuous to use that as a realistic multiple. Second, the price will come down as development costs are recovered, as competition arrives and ultimately when generics come. Third, this is a CURE. This is a rarity. Most products from biotech companies are expected to be used indefinitely and many times they have minimal benefits (e.g. cancer drugs that extend life only months). As a cure, that means for every usage the market for the drug is being reduced.

     

    As far as breaking the system, drugs as a percentage of total health care costs have been dropping for the last decade or two. Hospital costs have skyrocketed. Costs in the last couple of years of life dwarf any other time. Obesity (and the ultimate health costs from it) in this country has ballooned (pun intended) outrageously. Criticizing the cost of a breakthrough drug that will have a huge positive impact on health outcomes, while there are so many other egregious misallocations of capital in our health care system is unwise and inappropriate.

     

    Given that we are talking about a cure, if you are going to speak about curing everyone, this is virtually a one time cost. If you have any fairness in you, you will amortize a one time cost over many years to get a true valuation of the cost to the health care system. Gilead borrowed money for a number of years in order to develop a cure. The idea that insurance companies and health concerns can't calculate health care costs AND SAVINGS over a multi year period to find out a true impact of a drug defies logic. And the idea that you can't finance current costs from future savings denies one of the precepts of Obamacare (preventive care now reduces costs later).

     

    Gilead will be paying huge taxes on their profits so right there you can probably lop of 20% of the cost that will just be returned to our government. I would rather have the money in the hands of Gilead developing cures for more diseases, than in the hands of our government who would piss it away on fraud and waste.

     

    Finally, this has been on the market for what 8 months? Gilead is developing more formulations to both improve its offering for all the various genotypes. They have doubled their R&D expenditures. They definitely have not yet even recovered their cost of development. The FDA is largely responsible for these tremendous development times and costs to market. And one single problem in the drug could totally wipe out the ability to profit from it. No one should even question the cost to obtain this drug until Gilead has reaped a multiple of their development costs factored by the risk undertaken.

     

    The precedent has been established to offer drugs at a sliding scale correlated to per capita income. This is to give the world in general the same relative cost availability of a drug. Egypt is a special case with 15% infection rate due to reusing vaccination needles decades ago. So, they are getting an extra(10x) humanitarian discount in order for them to have a chance to make a dent in their problem. Can you imagine if the US had 15% instead of the 1% current rate? I can guarantee the cost would be much less(probably 10x) because a whole different level of considerations occur when you have those kind of numbers in terms of both humanity and affordability.
    20 Jul 2014, 07:54 PM Reply Like
  • zorro2828
    , contributor
    Comments (740) | Send Message
     
    Seriously,, greed? All investors risk their money to make a return.. it is the measurement of the risk and reward that is the process called "Doing your homework!"

     

    Americans do not live in a welfare state where the State pays for everything nor are we entitled to everything ... Hepliver, your socialistic agenda is so obnoxious to any investor, including GILD, who risked billions and now you want to deny them the opportunity to make money to develop more cures? GILD, put their money down, came out with a game changer and now you want the benefits without paying their price..

     

    If I were you, I would be thankful you live in a country where companies can deliver world class solutions to medical issues ... There is a Mayo clinic, which I am sure I could not afford .. but it exists.. that in itself is amazing especially when I travel to Kenya and see the slums where there is no medicine for much of anything!

     

    Truly I feel sorry that you live in America where all you do is complain about the bounty because you can not afford it.. Try working, investing and saving instead of complaining about such a great company!
    21 Jul 2014, 07:58 AM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    ..."such a great company." Yeah, that's the problem. The nation in your eyes is a company. Like many, I do work. I am not in a lucrative job of siphoning off bits of interest on trades and producing nothing or betting on the back end. That to me sounds more like a parasite than a functioning, useful member of a society.

     

    And yes, the United States of America DOES and ALWAYS has had some socialist aspects. That's perfectly fine. We have bridges, roads, social security, things that we should be proud to pay into.

     

    As to what Gilead "invested" - that's a common and typical lie and does not justify placing a price on their PARTIAL cure (two drugs are needed). The value is not just measured in the return-on-the-investment. That piece they've already blown WAY past in the first quarter. But fair pricing should be based on reasonable costs and returns. The cost to make the drug is probably $200 over 12 weeks, not $84,000. I'm sure you can look up, can't you?, the amount Gilead invested in the actual R&D to develop sofosbuvir and just their 1Q earnings on it.

     

    It's not a Ferrari or some fancy car. One could charge whatever one wishes but even the extremely wealthy would balk at some point--but no one dies if the car sits in the factory lot for a while.

     

    I'm not against a fair return. In fact, I would like to see a fairer system where DISCOVERERS were amply and reasonably rewarded. NOT stockholders. THAT brings us cures.

     

    I feel sorry for you that you don't understand what it means to watch people suffer and die, or have their homes go into foreclosure because of medical bills. That you are so wilfully blind to those readily available data and the impact of absurdities in drug pricing, for example, only shows how much of the kool-aid of the worst excesses of capitalism you are drunk on. There can be FAR more rational AND humane ways that do not require companies like Gilead from holding the lives of over 150 million people to their outrageous, unjustifiable and perverse ransom.
    21 Jul 2014, 09:29 AM Reply Like
  • derrickthms182
    , contributor
    Comments (653) | Send Message
     
    What an idea!! But congressman love socialism because they don't actually have to do anything unlike the hardworking taxpayer, including GILD, which through innovation, intelligence and long hours in the lab actually created something. The American dream. Supply and demand. Econ 101. LOOOOOOOOOONNNNNNNNNNN... GILD. And capitalism, freedom, AMERICA!!!!!!!!!!!!!!!...
    22 Jul 2014, 09:33 AM Reply Like
  • 13302632
    , contributor
    Comments (1772) | Send Message
     
    Hepliver,
    I've worked 100 hour weeks in R&D and started my own business with my own capital (which failed and I lost both time and money). So many people of your beliefs don't understand the concept of risk and the sacrifices made by those pushing the boundaries of discovery. There is no doubt that history has proved capitalism is by far the best (not perfect) system for accelerating human progress. I didn't go looking for a handout when my business failed, but if I had succeeded I would have wanted a fat reward for the sacrifices and risk undertaken. When you pay for a successful product you are also paying for all the others that were in the race but lost, otherwise no one would enter the race. Your statements show you may have worked hard in your life but you don't understand how capitalism works and succeeds. The fact that you think there can be some arbiter or committee that can figure out what is "fair", indicates you fall into the age old trap of socialism....living in the workers paradise full of 5 year plans. Markets and competition are the fairest thing you are going to find. Without them you would not be complaining about Sovaldi's price, because Sovaldi would not exist.
    22 Jul 2014, 11:14 AM Reply Like
  • Trying2StayFocused
    , contributor
    Comments (106) | Send Message
     
    "vicious attack on people living with chronic diseases by companies that are out-of-control"

     

    So, what have you done for these people?!? How dare you attack the very people who have developed a cure! You, sir, are dangerous.
    23 Jul 2014, 09:21 AM Reply Like
  • Trying2StayFocused
    , contributor
    Comments (106) | Send Message
     
    Hear! Hear!
    23 Jul 2014, 09:24 AM Reply Like
  • Chazuu
    , contributor
    Comments (263) | Send Message
     
    HepLiver
    Amen brother!
    20 Jul 2014, 03:52 PM Reply Like
  • Chazuu
    , contributor
    Comments (263) | Send Message
     
    jsijimmy
    Per the American Liver Foundation's web site: There are approximately 6,000 liver transplants performed annually in the United States.
    Currently, about 17,000 adults and children have been medically approved for liver transplants and are waiting for donated livers to become available. The waiting list grows every year.

     

    Does that answer your question?

     

    Most of the the people with Hep C will never have a liver transplant because there aren't enough donors - and society wouldn't pay for them if there were.
    20 Jul 2014, 04:52 PM Reply Like
  • derrickthms182
    , contributor
    Comments (653) | Send Message
     
    Ok so what "society" won't pay for them? Please get off welfare and get educated so maybe one day you could find a cure for something.
    21 Jul 2014, 08:56 AM Reply Like
  • Chazuu
    , contributor
    Comments (263) | Send Message
     
    derrickthms182
    I received my first paycheck in 1944 at the age of 14. I am still working (part time) at age 84. I have been continuously employed for 60 years-- That's my idea of welfare. I ran a family company for many years and served on the board of a NYSE company for 13 years. I am not against capitalism in any way.
    I am against the current mentality expressed by so many here that health is for those who can afford it and everyone else can just suffer and die.
    There was great community spirit during WW II and I believe it carried over to the day of the Salk polio vaccine. At that time there not a word spoken about the distribution being "socialistic". There was universal approval.
    Today is the day of "I've got mine. If you don't have it too bad!
    21 Jul 2014, 09:14 AM Reply Like
  • Chazuu
    , contributor
    Comments (263) | Send Message
     
    13302632
    You aroused my curiosity when you mentioned Gild increasing their R & D budget, so I checked. Here it is from their financial statements:
    2009 - $939.9 B
    2101 - $1,072.9 B
    2011 - $1,229.2 B
    2012 - $1,759.9 B
    2013 - $2,119.8 B
    Total for five years: $7,121.7 B
    If all their R & D budget went towards Hep C research, which seems unlikely, they are a wee bit short on the $11 B figure.
    21 Jul 2014, 01:42 PM Reply Like
  • derrickthms182
    , contributor
    Comments (653) | Send Message
     
    What does the B mean? are you sayingin 2009 it was 939.9 B$ because that actually means, 9.399 trillion $???????????????? Just wondering. I know it's not trillion. You get it?
    21 Jul 2014, 02:38 PM Reply Like
  • brthesac
    , contributor
    Comments (113) | Send Message
     
    I developed a pill that cures cancer but I want to charge $1k a pill. I'll just give it to close friends instead of selling it because Senators will have an issue with the price.
    21 Jul 2014, 01:52 PM Reply Like
  • Chazuu
    , contributor
    Comments (263) | Send Message
     
    Sorry. I should have said M.
    21 Jul 2014, 05:52 PM Reply Like
  • combatcorpsmanVN
    , contributor
    Comments (1284) | Send Message
     
    Well, if 'cost' is a concern w/ Sovaldi, Congress should cancel one F-35 and put the $50,000,000,000. toward removing a scourge of HEP C. Unfortunately, if that were to happen, Congress, BOTH SIDES OF THE AISLE, would use the money to fatten their Retirement accounts.

     

    Whining about the cost of Sovaldi compared to the actual cost savings is really a prime example of the stupidity of the people we send to Congress and the Senate.

     

    How do these morons get the honor of representing the taxpayer??? Their one and only goal is to get incredibly rich rather than serving America first and foremost.
    21 Jul 2014, 08:18 PM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    Whining about the price of sofosbuvir is not the reason Congress is a mess. It's a mess because pharma lobbyists, well-heeled and not doing anything that solves health crises, prevented even a discussion of price controls, like every other industrialized nation has (and negotiating best prices as a function of government in the US is only done by the VA). What I need to understand is how you people who think this price is fine can justify it. Not on the basis of recovering investment. Not on the basis of manufacturing price - that's about $200 for 12 weeks (not $84,000). And if it were JUST this drug and no other, it may not be a bad thing--but when insurance companies and entire states (e.g., Oregon) refuse to pay for it, people don't get the care they need. No, speaking of an only goal of getting incredibly rich, that's defining people like Gilead's CEO, John C. Martin, becoming a billionaire on the backs of the ill and vulnerable. That's not a reasonable profit...that's fiscal rape.
    22 Jul 2014, 10:30 AM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    But of course, I'm sure you'll all be happy to pay the extra premium costs. http://bit.ly/1A1Koy3
    As the two authors point out, it's not just the price of Sovaldi that's the
    trouble. The drug is highly effective and promises to save money on pricey
    hep C complications. "[T]he more important issue is the number of people
    eligible for treatment," the commentary notes. "Sofosbuvir is not really a
    per-unit cost outlier but is a 'total cost' outlier because of its high
    cost and very large population eligible for treatment."

     

    Of course, the notion that a drug price is predicated on future monies "saved" is novel and untested, even as it serves merely a perverse justification for what results in intentional, global and widespread suffering and death to serve the gods of greed. The "invisible" hand of the market rendered visible, and it's covered in blood, waste and small-minded foolishness.
    22 Jul 2014, 11:17 AM Reply Like
  • 13302632
    , contributor
    Comments (1772) | Send Message
     
    hepliver,
    "The "invisible" hand of the market rendered visible, and it's covered in blood, waste and small-minded foolishness. "

     

    Great prose, total BS. The invisible hand of the market is what has led the greatest nation on earth to make countless advances in human progress. In an alternate universe, you would be starving in some backward tribe until the asteroid hit that wiped you out.

     

    How do you explain why the biggest socialism experiments on earth(Soviet Union & Soviet BLOC, China, N. Korea) didn't produce workers paradises. After all they were based on committee deciding what was best for everyone. They came up with 5 year plans for progress. Yet, they collapsed as compared to the West because their allocation of capital and economic efficiency SUCKED. All systems have inequities, but trickle down really exists and a efficient economy raises all boats. Otherwise how do you explain smartphones that are provided a conduit to all human knowledge, and global communication to everyone in the world? Do only the rich possess these? Eventually they will cost as much as a pencil and will be universal. Most suffering occurs from lack of freedom and poor governments, not market capitalism.
    23 Jul 2014, 08:55 AM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    13302632--sorry but that's the kind of absurdity that renders "conservatives" non-credible. The Soviet Union and China were horrific autocracies. They weren't the biggest "socialism" experiments. Socialism in its saner form is a part and parcel of sane capitalist systems (or at least closer to it) as seen in western Europe. Perfect? I agree--never gonna happen. But "trickle down" as the alternative? Hardly. What we have in the US now is a result of that hands-off approach, where regulations are eliminated. The result? Widening income gap (a dangerous situation), jobs outsourced overseas where job security and the environment (that we ALL share) are not considered. Contracting middle class, increased poverty--Piketty outlines it quite nicely. Capitalism is NOT the demon--but rather the notion that profit must always rise without regard to health, labor or the environment. That's just NOT good for business. Models exist that show that these considerations can work together in much more sane ways.

     

    Just spewing the same old rhetoric will not save our species. Pretending a company like Gilead can rape the crap out of sick people and that somehow is "OK" is lousy business, horrible societally and despicable on a public health basis. They are the model of what is wrong with the rapidly distorting version of capitalism that is resulting in a corporate feudalism that over the long term is brittle and cracking. Not to mention contributing mightily toward the cooking of the planet. And if you deny anthropogenic climate heating, you may embrace that religion as strongly as the lies of trickle down or that ridiculous "invisible" hand (PEOPLE make decisions at the corporate level) -- and reality sadly will catch up.

     

    Smartphones? A good case for the mix that contradicts your point. Market capitalism HAS brought them to people globally and in affordable way. Why not drugs too? But many of the rare earths used to make them are acquired by companies that do not care that they are derived from slave labor and/or to fund violent revolutions. Pretending market capitalism is pristine is intentional blindness.

     

    What do I value? Honor, decency, dignity, truth. Crazy? Yes. Achievable? Never entirely--but business practices and business models CAN be based on these notions AND be reasonably profitable. Gilead is not reasonable--temporarily highly profitable and indeed the proximate cause of suffering and death on a global scale as they push horrific portions of the Trans-Pacific Partnership Agreement, for example, that would essentially eliminate access to generic antiretrovirals, for example, that will result in the horrific suffering and untimely deaths of literaly MILLIONS more men, women and children.
    23 Jul 2014, 09:41 AM Reply Like
  • derrickthms182
    , contributor
    Comments (653) | Send Message
     
    Oh my.................It's like a debate between Obama and Reagan. I'll stick with Ron every time.
    23 Jul 2014, 09:52 AM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    Derrick--you must be part of the 1% or 0.1%, eh? Or do you mean the Ron that raised taxes? Or the fantasy Ron of the right wing with his demonstrably failed supply-side "voodoo" economics of trickle down? (Which always reminded me of some incontinent old man...)
    24 Jul 2014, 06:46 AM Reply Like
  • CSYJ
    , contributor
    Comments (3859) | Send Message
     
    HepLiver, did you read the GILD 2Q14 transcript? I think it was very truthful, honorable, and decent for the company to say this:

     

    "Ensuring patient access to Sovaldi and all our medicines has been and will continue to be a top priority for Gilead. And we have been actively engaging with payors compelling the benefits of Sovaldi. In addition, we are committed to making Sovaldi available to patients in developed countries and have recently entered agreement with Egypt a country that has the highest presence of hepatitis C in the world."
    24 Jul 2014, 08:48 AM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    "Compelling the benefits" is a perverse phrase, don't you think, for an intervention that costs maybe $3/day to make but for which they are charging $1000? I am sure there were some heavy politicking for Egypt to get the 99% reduction in price (that no one there has seen yet). They're still making a substantial (and perhaps generally more reasonable) profit with the deal with Egypt. And it STILL exceeds the threshold for what is actually possible to do, which would be about $500/12 weeks and STILL be profitable to Gilead at the price (not $84,000).

     

    Further, you need at least TWO drugs to achieve the cure; sofosbuvir alone won't do it. So it may be a truthful statement (yes, they're COMPELLING insurers to pay their ransom), but "honorable and decent" are in no way connected with the arbitrary, capricious and cruel pricing policy that they have for this drug.

     

    Note, further: "...75 percent of the HCV burden is in middle-income countries such as China, Russia, India, Argentina, Thailand and Pakistan."
    Source: http://bit.ly/1z7YbBE

     

    So no, I think Gilead is run by insane, greedy, psychotic people who are causing people's lives to be held hostage to an outrageous ransom demand. And if you terrified of dying of cirrhosis or liver cancer and see this treatment withheld sheerly out of greed, then frankly, I think what Gilead is doing is the other end of the spectrum. They are simply put, terrorists, playing with people's lives for fun and profit and resulting in horrific global suffering and death in ways that have NOTHING to do with capitalism. (E.g., there is no "market" to compete for this product when they use intellectual property as a bludgeon to secure their ransom demands.)
    24 Jul 2014, 10:59 AM Reply Like
  • CSYJ
    , contributor
    Comments (3859) | Send Message
     
    Have you seen this page?

     

    http://bit.ly/18GUhRY

     

    Have you read this sentence on the page:

     

    The Support Path Patient Assistance Program will provide Sovaldi at no charge for eligible patients with no other insurance options,
    24 Jul 2014, 11:17 AM Reply Like
  • CSYJ
    , contributor
    Comments (3859) | Send Message
     
    More! How about this page and this sentence? It explains why Egypt first?

     

    http://www.gilead.com~/media/Files/pdfs/oth...

     

    Gilead is also exploring options to enable broad access to Sovaldi for hepatitis C in lower-income countries, adopting a systematic country-by-country approach initially prioritizing those with the highest disease burden.
    24 Jul 2014, 11:24 AM Reply Like
  • derrickthms182
    , contributor
    Comments (653) | Send Message
     
    No too busy ranting about how great socialism is
    24 Jul 2014, 11:26 AM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    LOL. You're kidding, right?

     

    I'm aware of Gilead's anemic, onerous and complicated patient assistance program and their vague and airy promises about other nations. These absurd crumbs and sleazy efforts wouldn't be necessary if they weren't trying to rape the crap out of people for no good reason whatsoever. It's not about "socialism" or "capitalism," to me, but rather about the abject greed that demands a $1000/pill on a drug they didn't actually do any R&D on, one for which the patent remains even in contentious dispute. If they were reasonable and had charged maybe $5000/12 weeks (which is still outrageously excessive in my view) and then entered into agreements where they either provided a small 1-5% over manufacturing cost or just let generics compete, that would be sane. What they're doing is not sane or honorable or sensible. It's just flat out evil and even states like Oregon have stopped treating people, the WSJ has had articles about how physicians have to face the Gilead death panels before they determine who MIGHT be treated.

     

    Try again.
    24 Jul 2014, 03:46 PM Reply Like
  • brthesac
    , contributor
    Comments (113) | Send Message
     
    Hepliver should advise all drug companies on price. IMHO.
    24 Jul 2014, 05:56 PM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    Be delighted to. And as far as socialism goes, we could save and redirect ENORMOUS amounts of federal funding by ending all the tax breaks, subsidies and off-shore hiding of profits that industries receive so amply (let alone bailouts). Gosh. That should give derrick the warm fuzzies, huh?
    24 Jul 2014, 06:04 PM Reply Like
  • brthesac
    , contributor
    Comments (113) | Send Message
     
    Heplive should also advise Congress. IMHO.
    24 Jul 2014, 06:15 PM Reply Like
  • derrickthms182
    , contributor
    Comments (653) | Send Message
     
    A bum off the street could advise congress and it would be an improvement.
    25 Jul 2014, 09:16 AM Reply Like
  • brthesac
    , contributor
    Comments (113) | Send Message
     
    Derrick- That was my point, of course.
    25 Jul 2014, 09:28 AM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    Uh-huh. About par for the course. We share a disgust for Congress, indeed, but no doubt for diametrically opposed reasons--though you do seem to favor welfare when it is for corporations, eh? Meanwhile, I feel confident that Gilead will treat a handful of people at their outrageous pricing, most will suffer needlessly at their brutal hands and you will profit handsomely! So it makes perfect sense that you would be happy to add (lame and rather infantile) insult to the injury of denying access out of greed! Which suggests to me that you suffer a kind of pathology that needs to be cured if humans are to get off the road to self-inflicted extinction upon which we have set ourselves (speaking in far broader terms which I am sure are well beyond your ability or desire to comprehend).

     

    Enjoy the fruits of your parasitism!
    26 Jul 2014, 08:01 AM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    http://wapo.st/1rHq02X
    re Oregon, as but one example - "At that price, the state would have to spend $360 million to provide its Medicaid beneficiaries with the drug called Sovaldi, just slightly less than the $377 million the Oregon Medicaid program spent on all prescription
    drugs for about 600,000 members in 2013. It potentially would be a backbreaker."

     

    But then I'm sure in your philosophy, Medicaid should be obliterated and people, if they can't afford it, well too bad, let them die, eh? Capitalism at its very finest?
    26 Jul 2014, 08:14 AM Reply Like
  • CSYJ
    , contributor
    Comments (3859) | Send Message
     
    HepLiver,

     

    Where did you get the $360 million figure? Is it authoritative, reliable, and validated? Who is making the assumption "...would have to spend..."? Based on what? Does the reporter from your link have a full and detailed understanding of the Oregon Health Plan? I don't think so. He is based in D.C.! How can he event pretend to understand what is going on really in Oregon? The number he quoted is unsubstantiated at best and at worst totally irresponsible.

     

    I would like to propose another more reasonable approach. Let's start with this brief summary "HCV in Oregon" issued by the Oregon Health Authority on June 12, 2014:

     

    http://1.usa.gov/1rV5QQu

     

    The document states:

     

    Hospitalizations

     

    For the period 2008-12 (2012 is the most recent year for which data are available), there were 3,917 hospitalizations in which patients were identified with HCV who also had a discharge diagnosis consistent with advanced liver disease (chronic liver disease, cirrhosis, decompensated cirrhosis, liver
    cancer or liver transplant). The number of hospitalizations averaged 783 per year...

     

    It is perfectly logical to initially imposing a strict coverage guideline for those sickest patients requiring hospitalization. Multiply $84K for a Sovaldi regimen by 783 comes out to be only about $66 million.

     

    In fact Oregon already drafted a very strict 14-step treatment approval guideline (a bit draconian IMO) for Sovaldi as detailed on page 586-587 of this massive document also issue on June 12, 2014:

     

    http://1.usa.gov/1qMoWb4

     

    Sofosbuvir (Sovaldi®)

     

    Goal(s) :
    Approve treatments of chronic hepatitis C which are supported by the medical literature and where there is medical evidence of effectiveness and safety.

     

    Length of Authorization
    Initial trial of 12 weeks
    Requires PA (Prior Authorization):

     

    Approval Criteria
    1. Is the request for treatment of Chronic Hepatitis C?
    Document appropriate ICD9 code:
    Yes: Go to #2 No: Pass to RPh, Deny for appropriateness
    2. Is the request for continuation of therapy? Yes: Go to “Continuation of Therapy” No: Go to #3
    3. What Hepatitis C genotype is the patient?
    Record Genotype:
    Record Genotype and go to #4
    4. Is the patient being prescribed the appropriate concomitant therapy based on
    genotype as seen in the dosage and administration table on the next page?
    Yes: Go to #5  No: Pass to RPh, Deny for appropriateness
    5. Is the medication being prescribed by or in consultation with a specialist in the
    field of gastroenterology, infectious disease, or hepatitis C?
    Yes: Go to #6 No: Pass to RPh, Deny for appropriateness
    6. If the patient has been treated with peginterferon and ribavirin before, do they
    have documented noncompliance to their previous treatment?
    Yes: Pass to RPh, Deny for appropriateness
    No: Go to #7
    7. Does the patient have a biopsy or other non-invasive technology (Fibroscan) to
    indicate moderate to severe fibrosis (stage 2 or greater) OR radiologic, laboratory,
    or clinical evidence of cirrhosis? OR has extrahepatic manifestations (vasculitis,
    glomerulonephritis, cryoglobulins).
    Yes: Go to #8 No: Pass to RPh, Deny for appropriateness
    8. Does the patient have a Child-Pugh score < 7 (compensated liver disease)
    Yes: Go to #9 No: Pass to RPh, Deny for appropriateness
    9. Does the patient have a HIV co-infection? Yes: Go to #10 No: Go to #11
    10. Is the patient under the supervision of an HIV specialist? Yes: Go to #11 No: Pass to RPh; Deny (medical appropriateness)
    11. If applicable, has the patient been abstinent from IV drug use or alcohol abuse for ≥ 6 months?
    Yes: Go to #12 No: Pass to RPh, Deny for appropriateness
    12. Does the patient have any of the following contraindications to therapy?
    Yes: Pass to RPh; Deny for appropriateness No: Go to #13
     Severe or uncontrolled psychiatric disorder
     Decompensated cirrhosis
     Pregnancy
    13. Does the patient have significant renal impairment (CrCl < 30 ml/min) or end stage renal disease (ESRD)?
    Yes: Pass to RPh; Deny for appropriateness No: Go to #14
    14. Is the request for sofosbuvir 400 mg daily? Yes: Approve for 12 weeks for initial therapy No: Pass to RPh; Deny for appropriateness

     

    Most important is the paragraph below from the "HCV in Oregon" document:

     

    Mortality

     

    Mirroring national trends, deaths from HCV have risen steadily over the last decade, averaging over 400 deaths annually in Oregon during the last 5 years.

     

    I hope you would agree that to spend $84K for each severely ill HCV patients at $34 million a year to save their lives is a fantastic value?!
    27 Jul 2014, 10:37 AM Reply Like
  • Rope a Dope
    , contributor
    Comments (706) | Send Message
     
    "and people, if they can't afford it, well too bad, let them die, eh?"

     

    If these people contracted HCV through intravenous drug use, then yes, letting them die works for me.
    27 Jul 2014, 11:24 AM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    CSYJ - "Prior authorization" basically means physicians have to beg and triage who they treat. This sounds like "death panels" to me. Of course, not everyone with high LDL needs drug therapy right away--that's for the physician and the patient to work out.

     

    So no, I absolutely do NOT agree that $84,000 is reasonable. It's evil, greed and you're being the most abject form of sophist to try to justify it. The consequence of it is INDEED to screw health systems around the world, let alone state medicaid--I find it laughable that you're best shot there is to pretend the numbers aren't real. Where what YOUR numbers suggest are that maybe 60,000 of the 3.5 million people with Hep C should get treated.

     

    If that number arose from a standard of care arising from medical consideration, it might be acceptable but we would have to have THAT discussion. But that is highly implausible given the public health imperative would be to treat everyone given the enormous societal benefit, the personal value, the short course and low side effects--and the VERY low manufacturing cost.

     

    But your framework is one of physicians begging, patients dying, insurance companies freaking out and entire health systems of nations obliterated by the economically genocidal pricing John C. Martin and his board of buffoons has chosen to foist upon us. That YOU think this $84,000/12 weeks is anything but murderous shows to me only how completely deluded you are--and wilfully blind.

     

    Rope-a-Dope (apt) - Why? Have you ever known anyone who was an IV drug user? Or do you just reflexively hate? What other populations should die? Anyone who smokes? Eats poorly/too much? How about non-whites in general? Maybe you don't like muslim? Die? Why not.
    27 Jul 2014, 12:57 PM Reply Like
  • CSYJ
    , contributor
    Comments (3859) | Send Message
     
    So HepLiver,

     

    It seems to me cost tis the only and the important issue to you?

     

    How do you feel about severe lack of liver donors in the US requiring liver transplant triage? What about the average cost of total liver transplant @ >$500K in the US? Are you saying perhaps we ought to jump on the atrocious "organ trafficking" scene and get the livers from, say China (w still got some time since reform in China is always slow)?

     

    http://reut.rs/1nTwjgz

     

    http://bit.ly/1nTwhW0

     

    http://bit.ly/1nTwjgI

     

    It's a lot cheaper at least for the organ itself! Would insurance company cover that? Perhaps you can start an advocacy group in the US to get livers from executed inmates here? Oops I forgot. The HCV infection rate is very high in the prison population. Maybe death row inmates ought be solicited to sign a paper committing their liver donation, in return for a free Sovaldi regimen starting 12 weeks BEFORE the execution?
    28 Jul 2014, 05:20 PM Reply Like
  • derrickthms182
    , contributor
    Comments (653) | Send Message
     
    Sir you are confusing freedom and morality. You have the freedom to give to charity that will help those people in need but don't force people to do it. Why force Gilead to work for free? You don't have a clue Hep. But don't feel bad many in congress fall into that trap or they pander to the poor for votes by offering them free stuff. There was a lady interviewed during the Obama campaign. They asked why she wants Obama elected. She replied ' because I won't have to worry about my gas, electric, rent bills anymore'. i.e. they'll all be free soon once everyone gets their 'fair' share.
    27 Jul 2014, 01:11 PM Reply Like
  • Rope a Dope
    , contributor
    Comments (706) | Send Message
     
    I deliberately live a clean life to preserve my health … and wealth. There is no reason for me to pay for someone who shoots up drugs and yes, they represent a significant portion of people who will need this $84,000 regimen; some twice due to high relapse rates.

     

    I am tired of the Liberal BS where people think that for some unknown reason, I should be held responsible for the behavior of others.
    27 Jul 2014, 01:31 PM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    If your definition of freedom is letting people die, you have a bizarre definition. But I think MOST people I know would be fine with paying their fair share. The point is that what Gilead is charging is SO way beyond either what is possible for MOST people, period. There is no BUSINESS need for Gilead to charge that much. They could make a huge profit that WAY exceeds the tiny costs of R&D they've expended on this drug. If the drug cost 99% less, they'd make money, people could afford it, insurance company and medicaid and other formularies wouldn't be depleted (raped)--it makes no FISCAL sense for anyone but Gilead to charge their ransom price. This fails from a conservative perspective. As a human being, I also embrace a perspective that sees helping the people that could not afford even a 99% price reduction as representing a small public investment for improvements and strengthening of public health. We spend a lot more than that on government subsidies of large corporations who then compound their sins of "welfare" by failing to pay taxes.

     

    To that extent, you're going to be held, Dope, along with the rest of us to a HUGE hit that may result in an increase in your insurance premium. Because of the vicious greed of companies like Gilead. That's not "Liberal BS" - that's just reality.
    27 Jul 2014, 06:25 PM Reply Like
  • zorro2828
    , contributor
    Comments (740) | Send Message
     
    Hepliver... Your comments are very disturbing.. not for the content as much as your attitude towards great American companies that come up with cures for illness and the fact you want to have a say in what they charge... that right belongs to the free market economy that we live in and that is why there is even a cure.. profits for incredible investment! Your comments are offensive and supercilious.. more Left wing Liberal nonsense that is not supported when looks at the financial numbers particularly examining what the drug will save the health system over the next 20 - 30 years
    28 Jul 2014, 09:40 AM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    I'm delighted you're disturbed. Clearly, you need to be since you're suffering some serious cognitive dissonance. If only 54,000 people are able to access treatment, how does that assure health system savings when 3.5 million are infected? See, my attitude is someone LIVING with this disease who wants a cure. So of COURSE I have every RIGHT and a DUTY to demand a reasonable price. Even in the pernicious context of the worst excesses of capitalism, what part of negotiating a price violates that fundamental tenet of freedom? Of a right to health?

     

    And where is the evidence these outrageous profits are going back into investing in cures? The data show that pipelines are narrowing, most cancers remain incurable, antibiotic resistant infections are on the rise, millions die of treatable infections worldwide. What fantasy land are you living in that you think pharma is doing the world that much good any more? When what we DO see is convictions for off-label promotion, convictions for fraud for suppressing negative or neutral data, exorbitant and absurd executive salaries and bonuses and corruption from China to Foster City?

     

    I WISH the pharmaceutical industry even REMOTELY approached your rosy-eyed view. I wish there was honor, generosity, common sense and a genuine desire to let science and medicine lead the way. Such honorable traits would serve the industry enormously well, allow for reasonable profits while assuring access to treatments and make them genuinely good investments. Sadly, such is not the case.
    28 Jul 2014, 10:08 AM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    ...and I used numbers just in the US...most middle income countries will NEVER afford even the 99% reduction on an absurd, ransom-demanding nightmare of a price that serves the fiscal interests of John C. Martin. Not the nearly 200 MILLION of us living with a curable infection--that requires ALSO a second drug at least.
    28 Jul 2014, 10:10 AM Reply Like
  • derrickthms182
    , contributor
    Comments (653) | Send Message
     
    Don't worry a competitor will soon come to lower the price thanks to good ole free market economics. Heck it may even cure it forever! Wouldn't happen in Soviet Russia. In soviet russia you don't take drug, drug takes you!
    28 Jul 2014, 01:48 PM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    Derrick, yes, a generic is already available in some countries. But you may not realize, pharmaceutical companies hide behind intellectual property laws to prevent access to generic competition while a drug is on patent. This does not reward the DISCOVERER nearly so much as the executive board and some stockholders. And, with other tricks, like evergreening, they can keep real competition OUT. So I've always been rather perplexed why conservatives fail to understand why we'd want market competition to operate in such a situation. IP has basically stymied new innovation far more thoroughly than it has stimulated it. Let alone the fact that consequent effects of absurdist "what the market will bear" (i.e., how much can we screw 'em?) policies lead to millions unable to obtain treatment, incredible suffering and death and all the societal consequences of that.

     

    By contrast, a compulsory license issued at the federal or state level could compel the import of generic alternatives, based on their biological equivalence. Given the feds reluctance to do anything but serve corporate profiteers, this seems less than likely, however, states may well take up the cudgel in order to assure access to their citizens. So yes, there may be ways to inject some really fair market competition into this, tho that may deleteriously impact John C. Martin's billionaire status, though I wouldn't be too concerned that it would.
    28 Jul 2014, 03:20 PM Reply Like
  • CSYJ
    , contributor
    Comments (3859) | Send Message
     
    So HepLiver,

     

    Do you support and/or endorse India's draconian, unilateral, and totally unfair attempts at either compelling compulsory license or denying patentability of biopharma drugs there?

     

    http://bit.ly/1o7AHEo

     

    I wonder how many Indian biopharma came up with any innovative drugs, ever, and why so many top notch Indian scientists come to the US to study, gain their degrees, and contribute as biopharma corporate staff. Ditto for how nay Indian doctors remain in the US to enjoy their status and income? I am sure you know a few... I know a LOT!
    28 Jul 2014, 06:04 PM Reply Like
  • brthesac
    , contributor
    Comments (113) | Send Message
     
    Keep it going. This is more entertaining than Twitter.
    28 Jul 2014, 05:32 PM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    First, let's be clear. "Gilead" is a legal fiction. There are people that work there. Guess what? NONE of them discovered sofosbuvir. And few of them had much nor did they invest much in the clinical evaluations of it. Not to justify their ransom demands, for sure.

     

    India is a vast resource of knowledge, traditional and otherwise. So yes, they most assuredly have, can and will come up with new treatments and therapies.

     

    As to the compulsory licensing regimes? You bet! Absolutely. Without them, at least 10 million more people around the world would have died of AIDS due to the economic genocide perpetrated by pharmaceutical companies' executives in their profound greed. Men, women, children are dying still because these companies choke off access. Though some are making some changes but they're not enough, anemic and usually merely a prelude to patent expiration.

     

    Glad you're entertained, brthesac. While you enjoy this as a form of mental masturbation, millions are dying for treatments denied by pharma's cruelty. The notion that such a framework is essential for innovation is demonstrably a lie and indeed, IP serves more as a disincentive and thickets of patents obliterate novel therapies from being developed with alacrity.
    28 Jul 2014, 08:17 PM Reply Like
  • CSYJ
    , contributor
    Comments (3859) | Send Message
     
    So HepLiver,

     

    Did Pfizer "discover" Lipitor? Made tons of money didn't they, even minimized revenue erosion for a while after patent expiration via clever rebates and co-pay schemes, right? Isn't that a fundamental tenet of capitalism and free market economy?

     

    Once again, did any Indian pharma ever "discover" a HIV drug? I am aware of no innovative Indian pharma, are you? Can you name a few and what wonderful and innovative drugs were developed by them that save lives (I am not talking about copycat generics)? Where is the "proof" for "have, can and will come with new treatments and therapies"?

     

    Indian researchers are indeed first class. But once again, how many of them would prefer working or actually work for an US or European pharma and get the big salaries and not for Indian generic firms with a fraction of what they pay here? Isn't that basic human nature?

     

    Speaking of IP, do you wear one of those "knock off" Rolex watches? Do you feel the musicians are entitled to their revenue from their music or do you advocate everything should be free? What about all the pirated movies all over the Internet? If you are against IP on drugs, you might as well get rid of all IP's for everything don't you think? Or are you having an issue on IP only with drug companies? Is that fair and/or logical?
    29 Jul 2014, 09:28 AM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    Interesting questions which you clearly haven't bothered to research, eh? First, "Pfizer" never discovered ANYTHING EVER. Maybe some researchers, actual human beings working at the bench, discovered some things. Maybe board or other humans decided to use funds to undertake animal or human studies, the work of which was carried out by people, some of whom may have been employed by the company.

     

    No--but then AZT, ddI, ddC and other HIV drugs were discovered by Japanese researchers and people who worked at the National Cancer Institute. Then licensed to companies like Burroughs-Wellcome to screw people at an outrageous price and screw taxpayers who funded the NIH research. Though I am a big supporter of NIH research and would like to see more, see it done better and the fruits of it be in the public domain.

     

    W/r/t statins or HMG-CoA reductase inhibitors, again, someone in Japan originally discovered the natural product that had the drug. Parke-Davis had an employee that later identified atorvastatin as a variation on a theme--one of the big problems to some degree is that very "me-too" drug syndrome that some criticize. Though I think it is important to have a range of options due to idiosyncrasies in therapeutic response, for example.

     

    My issue indeed is with IP being used by "companies" to enrich executives for products that are life-and-death. I do not wear knock-off jewelry and no one will die if someone wears a fake rolex (tho maybe of shame for wanting such a pathetic extravagance and only using a fake). I think ARTISTS should be paid for their work--not publishing company executives. I think innovation and patents were designed to encourage DISCOVERERS, not fat executives and parasitic investors.

     

    When a company like Gilead erects such a huge barrier to access with an absurd ransom demand, then their argument that they're saving future liver transplant or other costs is revealed for the lie that it is. Most people will never be able to access it. So yes, when people health and lives are on the line, I think it is very fair to focus on the relevant effects of IP on discovery, development and access--and what Pharma is doing is lethal, deranged, cruel, capricious and arbitrary.
    30 Jul 2014, 08:04 AM Reply Like
  • CSYJ
    , contributor
    Comments (3859) | Send Message
     
    Trust me I do my homework. Yes I was fully aware that Lipitor was "SNATCHED AWAY" from Wyeth when Pfizer came up with the higher bid for Warner Lambert and paid a handsome breakout fee to Wyeth. It's actually ironic that Pfizer ultimately acquired Wyeth and thus could have saved themselves something like $1 billion (the breakup fee).

     

    So here is again my point. I see nothing wrong with Big Pharma having only few innovative drugs acquiring innovative smaller pharma or biotech's with lots of innovative compounds. That's again part of capitalism and free market economy! It's no different than hiring more innovative R&D staff when your current ones are not very productive.

     

    Speaking of innovation, what is your though about Gilead being the pioneer and continuously innovative about the FDC (Fixed Dose Combination) and the STR (Single Tablet Regimen) for ART (Anti Retroviral Therapy)?

     

    I must disagree with your "IP barrier" claim as GILD is the first and the best among all to reach out and be a leader within Medicines Patentl. You would see that no other biopharma is visible within this very worthy initiative. GILD's commitment is clearly not only ground-breaking but ongoing! I wonder what your comment would be:

     

    http://bit.ly/1n3SWKF

     

    http://bit.ly/1n3SWKI

     

    http://bit.ly/1n3SVq7

     

    http://bit.ly/1n3SVqb

     

    Lastly, since you mentioned NIH, please note the content of the third link above!
    30 Jul 2014, 03:53 PM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    Given the horrific situation where most companies sought to assure high prices everywhere, regardless, and the consequences of needless suffering and death to millions, the idea of the Medicines Patent Pool was what I'd call "needlessly necessary." If the geographic reach of generic competition was unfettered, especially for drugs like but not restricted to emtricitabine, there would be no need for an MPP. And Gilead executives, frankly, probably did it because they saw the writing on the wall, rather than from giving two pins what happens to poor children in Zambia. That being the context, at least Gilead HAS joined the MPP, unlike other companies who are happy to let millions die and who are making third-line treatment for HIV unavailable. But the agreements, while in some respects an advance on a globally economically genocidal situation, are also rife with limitations in terms of geographic scope, where and how royalties are paid and sourcing of drugs, as you no doubt know. Further, Gilead executives FORCED groups like UNITAID to come up with novel solutions--pharma companies would never have bothered without people like me and others raising hell and demanding access to treatment at reasonable prices. Just like I'm doing now.

     

    Given there is no such mechanism for even more viciously priced sofosbuvir and the impact is largely among middle-income countries, your pleas to find me saying, "gosh, what a great bunch of people" is hardly going to be my reply. The barrier remains, and coinfection with HIV and hep C is clearly an horrific challenge rendered all the more horrible by the lack of generic sofosbuvir and daclatasvir, a combination that Gilead tried to block further study of. We need generics of both available and as I understand it, there is a challenge to Gilead's patent in India on sofosbuvir. I hope they tell Gilead to go take a hike. And I hope Brazil cuts a better deal than $13,000--absurd. They should be making their own since the people at Gilead are so greedy on a MAYBE $3/pill drug on which they want to charge such outrageous, access-blocking, killing markups on.

     

    Now tell me. Where's the "free market" when there's no way to make bioequivalent generic alternatives? Where's "competition"? Locked up in the executive board of Gilead whose death panels decide who lives and who dies?
    30 Jul 2014, 04:53 PM Reply Like
  • CSYJ
    , contributor
    Comments (3859) | Send Message
     
    I am realistic and practical and will NEVER expect you to say "great" about Gilead. The fact that you at least said "...Gilead HAS joined the MPP, unlike other companies..." is good enough for now!

     

    I am well aware of SOF/DAC combination's potential:
    http://bit.ly/1s7rPnt
    Perhaps you ought to "raise hell" and convince BMS to join MPP? Then I would be very optimistic that Gilead will not "block" any research. After all, nothing like a 100% cure combo right?

     

    Better yet, why not make use of your advocacy and persuasive skills, shuttle and mediate between GILD and BMS boards for a mutually agreeable terms so that they will resume collaborating for for the combo Phase III clinical trials? Why not ask Gates Foundation to subsidize the cost? Then appeal to the FDA for fast track and priority review, then work with the MPP, WHO, other advocacy groups for a consensus global price? Why not focus on positive and constructive actions rather than continuous negative complaints?

     

    Lastly, I am still not understanding thus questioning your philosophical position on IP, especially patents. Should Apple let anybody make and sell copycat iPhones? Do you own one? Would you gladly pay some Chinese firm a fraction of the Apple price and not let Apple garner the full spoils of their innovation? Or are drugs simply different? Are you advocating there should be no patents granted for drugs, period?
    31 Jul 2014, 02:16 PM Reply Like
  • CSYJ
    , contributor
    Comments (3859) | Send Message
     
    HepLiver,

     

    Did you see this?

     

    "FDA raises concern over drug production process at India's Cadila"

     

    http://reut.rs/1s8bEGx

     

    I hope you realize this is only the tip of the iceberg in terms of lack of manufacturing and quality standards of Indian generic drugs and companies. I am sure I don't need to get into the myriad of similar issues in the past few years (2012, 2013, 2014) with Ranbaxy!

     

    What happened to their "vast resource of knowledge"? What good is "coming up with new treatments and therapies" if they can't even pass FDA's inspection for manufacturing their "own" generic drugs.
    31 Jul 2014, 08:46 PM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    Wow, you are kidding, right? Am I surprised there have been problems at an Indian plant? No. Where are MOST drugs made? And what does it matter? We must ALWAYS be vigilant because companies too often care ONLY about the bottom line, no matter how many people they kill. Like this:
    http://bit.ly/1oV1dG6

     

    Another hideously overpriced drug that kills people. The FDA actually checks for bioequivalence and identity, potency and purity for generics for HIV, as you no doubt well know. For you to try to start fearmongering and smearing like that is not at all surprising but really, glass houses and all, you know?

     

    And there is a big difference between a knock-off smart phone and a properly made generic drug alternative. Millions don't suffer and die needlessly if they don't have an iphone. And an iphone doesn't cost $84,000. I still don't get how you can defend that kind of vicious rape.

     

    And thank you, I have other ideas for how to get daclatasvir and sofosbuvir available. Ever hear the term "compulsory license"?

     

    What little modicum of respect I may have had for you just evaporated.
    1 Aug 2014, 07:15 AM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    And by-the-bye, it wasn't BMS that scotched the studies, it was GILEAD. Not that this makes me any fan of BMS. Meantime, you might want to read this.
    http://huff.to/1liIqjg

     

    Why don't you get that this pricing is a serious issue? One that causes enormous global suffering and death? This isn't rhetoric. IT'S REALITY. You're company and its executives are MURDERING PEOPLE. People I know.
    1 Aug 2014, 07:31 AM Reply Like
  • CSYJ
    , contributor
    Comments (3859) | Send Message
     
    Well HepLiver,

     

    We will never agree on drug or Sovaldi pricing so let it be. I don't see any chance of re-condensing what has been "evaporated" anyway.

     

    So can I ask for your perspective in other areas based on your focus on "affordable medical treatment and therapies'?

     

    What about medical devices specifically AED's and IV infusion pumps? They save lives don't they? So should they be priced at say no more than $50? Compulsory licenses for their patents? What do you think the above would do to innovative medical device companies?

     

    What about US doctors (especially surgeons) charging outrageous fees and having ridiculous income? Are some of them your personal friends? Have you ever raised the subject? Would they remain your friends if you do? Do they have a right to earn their income under capitalism and free market economy? They sure save lots of lives don't they? Should they be forced to practice outside of US during their career or part of the year as a compulsory requirement of their license to practice in the US?

     

    What about outrageous product liability and malpractice awards? You know the numbers don't come even close (if even allowed to proceed in a court) in other countries right? They sure contribute to the high healthcare cost in the US don't they? Ever wondered why Obamacare didn't even touch or consider tort reform? Ever wonder why so many OB/GYN's are no longer taking new patients or getting out due to exorbitant malpractice premiums? It is having a chilling effect on potential saving lives, no? Should there be a maximum ceiling for the awards? Insurance companies would love that!

     

    Lastly, what is your view on medical tourism? Why do you think it is becoming more popular? Would you advocate Medicare, Medicaid, and insurance companies to cover it? What about a package deal to see the pyramids and then get treated for a week or two at an Egyptian government endorsed hospital then take the rest of the 12-week regimen of Sovaldi back to the US? After all, it does save a lot of money and will save lives too, right?
    1 Aug 2014, 05:33 PM Reply Like
  • derrickthms182
    , contributor
    Comments (653) | Send Message
     
    That'll take some days to answer. Actually for Hep maybe one. Nevertheless it will be a doozy! It's like hearing two professors with different theories on how the universe came to be.
    1 Aug 2014, 08:13 PM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    Oh, I see, you cannot ever justify the outrageous price that has just caused Illinois Medicaid to stop covering sofosbuvir so killing more people so let's change the subject? Seriously?

     

    So you ask a bunch of absurd questions. Why the hell do you think "medical tourism" is becoming popular? Because MOST drugs, devices and diagnostics are becoming ridiculously expensive--and now Gilead wants to up the ante to make it even more absurd and impossible. Precisely how medical care in the USA has been steadily deteriorating. And how about importing generic sofosbuvir and daclatasvir so state Medicaids aren't raped?

     

    Or better yet--how about those greedy, small minded little dingbats at Gilead just dropping the price by 99% for everyone? They'd STILL make a huge profit and treat a lot more people.

     

    So if you're a "former" Gilead employee--where did you end up?
    2 Aug 2014, 07:49 AM Reply Like
  • CSYJ
    , contributor
    Comments (3859) | Send Message
     
    HepLiver,

     

    Curious you never said anything about US doctors' financial well being. You never respond to my question about physicians and their astronomical income? Could it be you indeed have some friends who are physicians? I suppose you feel their compensation are fair and justified compared to their peers in other countries?

     

    BTW Illinois Medicaid's draconian 25-step Sovalldi coverage approval process is even worse than those of the 14-step Oregon one. Could it be an obvious and strong message to AbbVie for the pricing of their HCV combo? I am AbbVie would be eager to capture most of the IL Medicaid eligible HCV patients, don't you think. It is clear that efficacy, safety, convenience are of secondary concern to pricing. It's a sad testament to the current HCV medication scene!

     

    Do you really feel innovation in the US for medical devices and drugs are deteriorating? I am sure 99.9% of health care professionals would disagree. So what price for innovation?

     

    Lastly, I just became aware of this amazingly innovative device that will totally revolutionize cardiac arrhythmia monitoring:

     

    http://bit.ly/1pPX9DD

     

    How much should charge for this device? How much would you feel as fair, equitable, and justifiable? It surely will save lots of lives. It will also lead to optimal anti-arrhythmic agents/drugs. Would you advocate for and require any implanted patients with subsequent prescription restricted to only generic heart medications? Would you want to see Medtronic to accede to a compulsory license to some Indian medical device firms?

     

    What is your opinion about "American exceptionalism" BTW? It seems to me all you want is for us/US (pun intended) to give fruits of our innovation away to other countries.

     

    If you are truly committed and dedicated to make an impact on maximizing global medicines availability, there are groups such as

     

    http://bit.ly/1pPX9DE
    Médecins Sans Frontières!

     

    and for maximizing cures with lots of financial backing, what about the Gates Foundation? Let them know your availability! Channel all your negativity to positive contributions (your time)?!

     

    Continued and incessant vitriol in SA posts or comments are not gonna cut it, right?
    2 Aug 2014, 08:04 PM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    You seem abjectly DESPERATE to dance away from Gilead's genocidal pricing of sofosbuvir, eh?

     

    But, without going into answering all your interesting tho disingenuous questions as they are intended to deflect from the topic at hand, in sum they DO bring up the notion of context. And the fact that you can't see how Gilead's pricing of this drug--AND let's be clear, my hatred of the people at Janssen for pricing simeprevir at $66,000/12 weeks, a crappier drug in many respects--that these policies impact ALL those organizations negatively is what astounds me.

     

    I'm a HUGE fan of MSF--they do work in places most people wouldn't even contemplate visiting.

     

    And getting Gilead's executives to drop the price of sofosbuvir by 99% IS a fine use of my time--and making sure people who need it can access it and daclatasvir together.

     

    Just briefly--you as a pharma minion should love exorbitant physician's salaries as they are primarily in specialized fields like oncology and--gastroenterology, right? But they have to also pay back huge and absurd student debt so fewer GPs, right? Another impact of letting insane greed be the sole motivator people have?

     

    You bet. The fact is, while a good income is an important motivation, MOST people I've know who are researchers (some even with pharma companies), professors, physicians, nurses--their motivations aren't about greed and screwing the life out of systems like it is for your friends at Gilead. It's about healing, about medicine, about science, about curiosity and discovery and alleviating suffering.

     

    I'm sure you have another litany of deflecting questions that try to move away from what more and more people are recognizing is an abjectly failed "business model" of discovery that sofosbuvir represents.
    3 Aug 2014, 09:13 AM Reply Like
  • derrickthms182
    , contributor
    Comments (653) | Send Message
     
    Hep I admire your love for others especially the poor and helpless but this form of economics is the best we can do with the human condition. Born with greediness, pride, jealousy, etc one cannot create a Utopian society with these inherent traits. It will only get worse not better. So we applaud companies like Gilead and others that come up with treatments and cures for illnesses that have plagued man for centuries. Would HepC, AIDS, cancer be a modern virus if civilization had not evolved? Maybe, maybe not. Would Gilead be here if civilization had not evolved? Probably not. So it's like the chicken and the egg, which came first, who created what? What if Government ran Gilead? We would not be able to even access its' website much less get a cure from it. Does it matter in God's plan that there is a cure for HepC, maybe. Truly admire your passion for others. Like the modern day Ghandi. See you in heaven Hep.
    29 Jul 2014, 01:17 AM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    LOL...because "Gilead" will have killed me? Possibly. And certainly millions of others.

     

    Let's be clear. This is NOT speaking of utopias. This is talking about living in a rational world where companies are not permitted to rape customers with outrageous pricing and fine print. Playing fair and rationally makes business work honorably. And demanding a fair price is as American as apple pie. This is just a corporate "taxation without representation." Hiding behind IP that they DID NOT ORIGINATE to cruelly justify this absurd, health care killing pricing is the bloated, rotting stench of a capitalism rotting from within.

     

    And clearer still: GILEAD, legal entity that it is, did NOT discover sofosbuvir. John C. Martin and his board of buffoons merely bought it.

     

    I used to feel more strongly that public-private partnerships could work well but I think a privatized model of drug discovery has proven to be a vast and profound failure. I also know government alone can become overly bureaucratic and dismal--but now it's overly bureaucratic corporations that run the government, dismal and disdainful. A dangerous situation ultimately for all of us, particularly as we stand on the brink of self-inflicted extinction.

     

    And no, you're wrong. "Capitalism" unfettered is NOT the best we can do. It's evolving into a crappy feudalism that concentrates wealth in the hands of the 1%. What good does that do? Don't you get how brittle and incredibly dangerous that is? John C. Martin and Board CHOOSING to rape people with hep C with this ransom demand are a symptom of a profoundly ill society.

     

    I think not only CAN we but we MUST do better. I look to western Europe as having somewhat better if not ideal models. But what we have in the USA is collapsing rapidly. The economy is declining for the majority, education and health unaffordable, working people forced onto food stamps, infrastructure rotting, global heating so let's frack more CO2 and methane into the air...if this form of capitalism is the best we can do then we are really screwed. Not just as a nation...
    29 Jul 2014, 08:08 AM Reply Like
  • peggysis64
    , contributor
    Comments (3) | Send Message
     
    I really don't understand how 84000 for a cure can be having that much of an impact, when treating long term or a liver transplant costs how much? Maybe it is felt short term, but what about a year or two down the road when Medicaid is not having to pay for those long term treatments or the liver transplants which may or may not take and have to be repeated.
    1 Aug 2014, 10:44 PM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    Well, first, $84,000 is for ONE drug and NOT the cure. You need a SECOND drug. Second, that figure is for 12 weeks of therapy (and means paying $1000 for each pill that costs about $3 to make). Third, how many people die waiting for a liver transplant? Depending on what state you live in, if you're on a waiting list while on Medicaid.... Fourth, there is NO JUSTIFICATION for this brutal, insane and despicable pricing unless you're parasitically cashing in on a short-term bump in Gilead's stock price which I'm pretty sure is not sustainable (and the absolute wrong way to go about the practice of science and medicine).

     

    Try reading this:
    http://bit.ly/1AKp4gF
    World Hepatitis Day: Celebration of a new cure or commiseration for those who can’t afford it? Posted by Mohga Kamal-Yanni on Jul 28th, 2014

     

    http://hrld.us/1AKp4gI
    2 Aug 2014, 07:53 AM Reply Like
  • CSYJ
    , contributor
    Comments (3859) | Send Message
     
    Hello Peggysis64:

     

    The Gilead combo of Sovladi plus ledipasvir, when approved in October, will be a cure! It also may cut the treatment regimen time to only 8 weeks!! There are lots of other competing drugs coming online in 2015. Liver transplant averages >$500K when all costs are added up even in 2007 (see page 8 of the PDF)

     

    http://bit.ly/1qUdptB

     

    http://bit.ly/1qUdptD

     

    Liver re-transplant rate is about 9% 1996-2005:

     

    http://bit.ly/1qUdptG

     

    Medicaid does pay for liver transplant with some reasonable and logical conditions and the new HCV drugs will eliminate such needs.

     

    http://bit.ly/1qUdptI

     

    Accuracy, reliability, and validation are important rather than convenient and self-serving links with regurgitated contents
    4 Aug 2014, 10:07 AM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    New HCV drugs will NOT eliminate that need if they are priced as insanely as Gilead has undertaken--we will then have the double whammy of HUGELY increased costs for treating a few people AND the continued costs of people dying of liver disease needlessly because of the abject greed of Gilead and other companies. You sure you don't work for Gilead? Speaking of self-serving links and regurgitated contents!

     

    And yes, they know they will be literally consigning millions to early death and horrific suffering but they do not care. This is economic genocide. And you can see that the NORMAL rationale for drug pricing--cost of R&D--was long ago met. This new nonsense that "saving future monies" is a fabricated notion to justify screwing sick people to death and destroying an already weak and fragmented health care system.

     

    Here is the Senate letter to John C. Martin, making a KILLING on the market: "In its final audited financial filing with the [SEC], Pharmasset reported that its research and development costs totaled $176.7 million" --in short-- Gilead made its R&D costs back in the first month or less. The notion of "saving future money" rationale is absolutely evil and must not be countenanced as a justification for fiscal rape and these horrific ransom demands by Gilead's public health criminals.
    http://1.usa.gov/1pAqTXR
    5 Aug 2014, 07:03 AM Reply Like
  • CSYJ
    , contributor
    Comments (3859) | Send Message
     
    Yes HepLiver I read the entire Wyden/Grassley letter several times already. So since you are so obsessed about Egypt and $900 and 99% discount, are you saying what Pharmasset was planning on per their "commercialization forecasts" (priced at $36K) acceptable? You do realize that number was probably based on Pharmasset's already sunk in investment on sofosbuvir R&D thus excludes GiLD's acquisition investment of $11+ billion, right? If Pharmasset were independent and launched sofosbuvir at $36K per regimen, would you be as negative towards the company, or are all these comments just for your personal animosity against GILD? Action speaks louder than mere words right? "...My hatred of the people at Janssen for pricing simeprevir at $66,000/12 weeks..." I did not see a lot of vitriol comments by you on any of the SA Janssen posts! Pray tell!!
    5 Aug 2014, 02:38 PM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    Maybe you've read it as a defendant, but others may not have. And absolutely not. $36,000 is obscene--how you can think $84,000 is "acceptable" is strains all credulity.

     

    Gilead buying an ENTIRE company for $11 billion is NOT a factor in pricing a single drug--unless they did something really STUPID like buy a company that had only one drug in its portfolio? Would they be that incredibly stupid? (When ostensibly it only costs $1 billion -- probably $125 million on average really -- to bring a drug to market.)

     

    So you think I am justified in hating companies that erect enormous barriers to care yet somehow feel that poor little Gilead and it's Billionaire CEO John C Martin are being picked on? That all this profit they're screwing out of people is doing anything but enriching him?

     

    Sofosbuvir is a more important drug than simeprevir. And I will be working hard to see that it is available to people who need it AND a second drug which is REQUIRED to achieve the cure--which I think better than ledipasvir is daclatasvir.

     

    Holding people's lives for ransom is considered a criminal enterprise. Wouldn't you say that's the case? When someone tells you pay us our ransom demand or drop dead? Suffer first? Isn't that what this is? Not to mention price fixing hiding behind IP? Setting a ridiculously high bar that causes death and suffering needlessly so John C. Martin can fatten is ample portfolio (personal, not in terms of medicines).
    5 Aug 2014, 03:12 PM Reply Like
  • CSYJ
    , contributor
    Comments (3859) | Send Message
     
    HepLiver, can't you be positive for a change? Do you know any or heard of any HCV patients who cannot afford Sovaldi and have tried to obtain it via this page?

     

    http://bit.ly/18GUhRY

     

    I am mot sure whether you personally need Sovaldi for yourself but if you are willing to be positive and constructive, even you can get a favorable response by calling the 800 number?! Why not be an advocate who can lead others in need to this "path"?

     

    So that you know, I have a family member who needed CNS medications for a while BEOFRE Obamacare kicked in. Applications to BMS and Abbott (before the split) was easy and without any hassle. After submitting the necessary documents for income and unemployment status, both companies actually sent the medications directly to home as three-month suppies without having to go through any pharmacy. Compassionate care does work and is in place with just about all major biopharma's!
    5 Aug 2014, 03:29 PM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    I have known people who cannot get through, whose doctors refuse to do the paperwork, who insurance companies said no. Why do we have to go through all that hassle and BS when Gilead could just be decent, humane and responsible and drop the price significantly? Why do we have to beg for what is not really there property? I am going to advocate that people get the best possible treatment and not be raped by Gilead. And that our health care systems not be raped by Gilead as this is the parakeet in the mine of death pharma is creating due to its narrowing pipelines of discovery, impacted in no small measure by the thicket of patents and licensing agreement costs and demands that stymie actual innovation.
    5 Aug 2014, 03:55 PM Reply Like
  • HepLiver
    , contributor
    Comments (922) | Send Message
     
    Wow. What delusional crap. Why should "compassionate care" be even NECESSARY? If Gilead just did the humane, just and decent thing and DROPPED THE PRICE by 99%, it wouldn't be necessary. AND people ARE being denied. In Oregon and Illinois just to begin with. The paperwork is onerous, to put it mildly. Prior authorization is absurd beyond belief--doctors refuse to be bothered with it.

     

    Why put people through this onerous bureaucratic process that is more something like out of a Kafka Soviet-style horror story just to service a ransom demand by an unethical, criminal cartel like Gilead?
    5 Aug 2014, 04:12 PM Reply Like
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