If you have hepatitis C, do you remember how you felt when you learned that the new drug Sovaldi was approved—a drug that is sometimes used without interferon—a drug that cures hepatitis C nearly 90% of the time—and does this with only 12 weeks for most patients. I was so happy—filled with hope for all of you who have not yet “slayed this dragon” as many hepatitis C patients refer to it. Sovaldi (sofosbuvir) was one of the drugs in the hepatitis C treatment cocktail that cured me, and now it is here, really here. Granted, there are potentially better hepatitis C drugs around the corner, many of them worth waiting for if your doctor says you can wait. But, for those who can’t wait, or don’t want to, up to 90% will be cured now.
Then I saw Sovaldi’s price tag—$1000 a 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 decent house in some states. If you have genotype 3, or you are an interferon-intolerant genotype 1, a 24-week supply would cost $168,000. If you have liver cancer and awaiting transplantation, the cost of 48-weeks of treatment is $336,000.
My heart sank; my liver shuddered. It never occurred to me that this drug would cost so much. There was no reason for it. In the January 2014 journal, Clinical Infectious Diseases, Andrew Hill and colleagues estimate the true cost to be $68 to $136 for 12-weeks of Sovaldi. Multiply these estimates by ten or even a hundred, the cost seems reasonable; $84,000 does not.
The press has noticed. The subject of Sovaldi’s price is appearing with regularity in newspapers across the country—from the The Washington Post to The Union (my local Grass Valley paper). Insurance payers have also noticed. Molina Healthcare has told Medicaid officials that it cannot bear the cost. Express Scripts is asking medical providers to delay prescribing Sovaldi for patients who can wait. Officials in some states are reviewing Sovaldi’s pricing. Questioning the price makes sense. In the Guardian Liberty Voice, Gabriela Motroc wrote, “ If state health officials would accept to pay for each American suffering from this disease, it would cost $227 billion, which is a huge amount compared to the approximate $260 billion spent on a yearly basis for all the drugs available in the country.”
Challenging the price makes sense—unless you are a patient. Can you imagine if hepatitis C treatment comes down to price? What if you could be cured but your health-payer denies coverage? Well, actually, we already have that situation in the U.S. Insurance companies have been denying treatment or insurance for decades. Now they can’t deny insuring people, but they can refuse to pay for certain treatments.
What does Gilead say to this? An article written by Drew Armstrong for Bloomberg News quotes Gilead official Gregg Alton, “Older therapies were not sufficiently effective or tolerable to continue to be used as the standard of care.” This is true, but not justification for the price tag. In fact, one could argue that this is the reason that Sovaldi should be cheaper. Charging $84,000 because Sovaldi works up to 90% of the time seems exploitive to me. I don’t know what else to call it.
I am so appreciative of Sovaldi, and the hope it brings. I am grateful to those who worked hard to develop this drug and bring it to market. I am thankful that I am free from hepatitis C because of these new hepatitis C drugs. I am fine with Gilead making a profit on hepatitis C, since they have an obligation to their shareholders to make money. But when profit becomes exploitive, it is time to take a fresh look.
In the interim, I pray that no one dies because of Sovaldi’s price tag.