Health Column: The $1,350 pill, medication miracle or bank breaker?
MOHLER’S MEDICATION MAXIMS
Free Press Health Columnist
Hepatitis C is an important disease in our country. Over 3 million Americans are infected, half of whom are undiagnosed. Eighty percent of those who acquire an acute infection go on to develop chronic hepatitis C that may progress to scarring of the liver (cirrhosis) and liver cancer. Sharing of contaminated needles among IV drug abusers is the common mode of transmission in the United State. Blood transfusions were a frequent cause of Hepatitis C until the early 1990s when universal Hep C testing was implemented.
The treatment of Hepatitis C has been problematic, even in the recent past. Medication regimens were complicated, toxic, required a year of treatment and were successful only 50-80 percent of the time. Then in late 2013, the FDA approved Solvaldi for treatment of Hepatitis C. The studies securing Solvaldi’s approval were relatively small, but suggested cure rates of over 90 percent, taking only a single pill once a day. Solvaldi was associated with very few side effects. Too good to be true? Unfortunately, yes.
The $1,000 pill! I was sure I had heard it wrong, but “no,” my pharmacist colleague repeated the message. Gilead released their new “wonder drug,” Solvaldi, for Hepatitis C at a very large round number of $1,000 per pill. It makes it very easy to calculate the cost of a course of treatment: eight weeks (56 days) $ 56,000; 24 weeks (168 days) $168,000, you get the idea. And then, a few weeks ago, Gilead rolled out another product, a combination pill of Solvaldi and another Hep C anti-viral (Harvoni) that sells for $1,350 per tablet. This is higher math, but you can buy a 24 week course for a mere $226,800.
The responses from patients, physicians, legislators and insurance companies have been angry, filled with charges of greed and expletives not printable in a family newspaper. Doctors without Borders (the same guys and gals who have put their lives on the line fighting Ebola) have been minimally successful in poor countries in getting the price for a course of treatment reduced to $2,000. This is of little benefit in places where patients cannot afford a dollar a day for malaria treatment.
Gilead has been sinister in their pricing. The price for Harvoni in Canada is about $900 a pill, while in Britain it sells for about half the U.S. price. The National Health Service, the agency in the U.K. that makes medication coverage decisions, has voted not to cover Solvaldi or Harvoni. Gilead claims that in the long run their expensive product will save money, preventing liver cancer and liver transplants.
In the U.S., government insurers (Medicare and Medicaid), as well as commercial insurance companies are scrambling to sort out their coverage policies. They feel a moral imperative to pay for a drug that appears to be an important medical breakthrough. On the other hand, the economics of paying out close to a quarter of a million dollars for a single course of therapy for one patient represents a real threat to the solvency of health insurers. What medications, surgeries and other procedures will we have to cut to pay for Hep C treatments?
My Take: Effective new therapies in medicine should be rewarded. The egregious prices for Solvadi, Horvani and many new cancer drugs however threaten our ability to finance other needed care. In the U.S. we spend twice as much per capita for health care than any other country in the world. However, we rank far down the list in terms of our health-care outcomes. Gilead is an easy target, but we all need to understand that the health-care purse is not bottomless. We need to start making some difficult decisions about what we can afford medically and what we must forgo.
The opinions expressed in this column are my own and may not reflect those of Rocky Mountain Health Plans or Primary Care Partners.
Free Press health columnist Dr. Mohler has practiced family medicine in Grand Junction for 39 years. He has a particular interest in pharmaceutical education. Phil works part-time for Rocky Mountain Health Plans. Email him at firstname.lastname@example.org.
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