3rd largest Medicaid program didn't spend a dime on Sovaldi due to high cost
- A new Wall Street Journal analysis of federal Medicaid spending data across the country underscores the combative relationship between payers and Gilead Sciences over the exorbitant price of the biotech's hep C cure Sovaldi.
- Medicaid beneficiaries' access to Sovaldi varies widely from state to state, according to the data, depending on individual states' Medicaid program policies. For instance, Texas' Medicaid program didn't spend any money at all for the drug, citing cost concerns.
- All told, the analysis finds that state Medicaid programs spent as much on hep C therapies (mostly Sovaldi) in the first three quarters of 2014 as they did in the previous three years combined.
The battle between payers and Gilead (and other manufacturers of pricey next-gen therapies in the HCV, cancer, and CVD risk maintenance spaces) rages on, and the Journal's analysis of federal data underscores just how splintered access to drugs like Sovaldi has become in the face of various public and private payers pursuing different avenues to try to pressure Gilead into lowering its price.
Still, as this WSJ chart shows, some payers (such as New York's generous Medicaid program) have really ramped up their overall spending largely because of the costs of Sovaldi:
The Lone Star State is one glaring exception to this. A state spokesperson told WSJ that "price was the biggest issue" preventing the state from spending money on Sovaldi, and that they are instead providing AbbVie's Viekira Pak (but only to patients with the most advanced liver disease).
Gilead has already had to agree to provide substantial rebates in the wake of pricing pressure from groups like Express Scripts and competition from AbbVie (not to mention incoming competition from Merck's HCV combo therapy). But it may take even more discounts—or at the very least, a much more persuasive marketing strategy—to get payers to shell out enough cash that a larger share of hep C patients, and not just the sickest, can access medications like Sovaldi.