In big win for pharma, advocates urge WH to push broader Medicaid hep C coverage
- Various states have restrictive policies in place to bar patients from accessing new hep C drugs, such as Gilead's Solvadi and Harvoni, and AbbVie's VieKira Pak. The goal is to save money.
- Numerous groups, including the Public Health Service, President Obama's Advocacy Council on H.I.V./AIDS, and the Centers for Disease Control and Prevention (CDC) have told the administration that the restrictions being used to deny treatment are discriminatory.
- Guidelines from the Infectious Disease Society of America (IDSA) and the American Association for the Study of Liver Diseases state that any person with hepatitis C should be treated with one of the new hep C drugs—unless they have less than a year to live.
Some examples of restrictions being used by Medicaid authorities to limit access to hep C medications include: denying treatment to anyone who has abused drugs or alcohol in the last 12 months; having to receive treatment via a prescription from an infectious disease specialist; and only covering treatments once a patient is very sick. According to the IDSA, policies like these are not evidence-based or medically valid.
Despite this outcry, President Barack Obama's administration has been hesitant to set hard and fast rules for Medicaid agencies—a fact that has been frustrating to hep C patients, advocates, and (of course) the biopharma industry. Matt Solo, executive director of the National Association of Medicaid Directors, has conceded that once discounts are factored into treatment the prices fall from the $84,000 to $94,500 range (for Sovaldi and Harvoni, respectively) to around $50,000.
An advisory panel to the White House has suggested that states disclose how much they are actually spending on the new hep C drugs—and, in turn, Salo has requested that Gilead and AbbVie disclose the development costs for their hep C drugs.