When the newest hepatitis C drug Sovaldi, was approved by the U.S. Food and Drug Administration (FDA), you could practically hear the cheers ringing over the Internet. This is the first all-oral hepatitis C treatment, and although most genotype 1 patients will still need to use interferon with Sovaldi, it was still good news. The FDA opened the door to using Sovaldi without interferon for those who can’t take the injectable drug.
Additionally, there are other formulations in the pipeline, and it is likely that all-oral treatments for everyone will be available by the end of 2014. For those genotype 1 patients who can’t wait, there is also the option of using Sovaldi with peginterferon and ribavirin for a mere 12 weeks. With possible response rates around 90%, this option is still cause for celebration.
Moments later, the good news was slapped down by the announcement that Gilead would sell Sovaldi at $1000 per pill. A 12-week supply would cost $84,000. Add the cost of peginterferon, ribavirin, lab tests, medical visits, and medications to manage side effects, and you could buy a house in some states, especially in the Detroit area. For more about the cost of Sovaldi, I recommend reading this press release by the Fair Pricing Coalition.
Taking the sting out of the price, Gilead offers and participates in programs that make Sovaldi more affordable. The SupportPath patient assistance program offer help to those who meet the generous eligibility criteria.The SupportPath co-pay coupon program will provide co-pay assistance for eligible patients with private insurance who need assistance paying for out-of-pocket medication costs. Most patients will pay no more than $5 per co-pay. Gilead contributed to the Patient Access Network for co-pay assistance for Medicare Part D clients, and initiated an emergency Sovaldi supply program for patients that may lose their prescriptions.
However, what do I say to the patient with cirrhosis who emailed me from Egypt that he was going to fly to the U.S. so he could begin his treatment? I asked him if he knew the cost of Sovaldi, and after breaking the news to him, I listened to the distressing words of a man who may die without this drug.
I did not tell him that experts estimate the true cost to be $68 to $136 for 12-weeks of Sovaldi. In the January 2014 journal, Clinical Infectious Diseases, Andrew Hill and colleagues predict manufacturing costs for 12-week courses of $21- $63 (USD) for ribavirin, $10 – $30 for daclatasvir (not FDA-approved yet), and $130 – $270 for simeprevir. These numbers make it possible to treat hepatitis C globally in the next fifteen years.
Still, what do I say to the patient who may be dead by the time affordable treatment arrives in Egypt? It is like this photo I took in Egypt. The doors are open, but the guard may not let you in.