Hepatitis C is a disease that causes chronic liver problems, which may often be fatal. Traditional treatments for the disease have generally only been effective in only 50-80% of people infected with the disease. But a new drug introduced in 2013, called Sovaldi, could revolutionize Hepatitis C treatment–it can be up to 90% effective.
The only problem? Sovaldi is extremely expensive. It can cost up to $1000 per pill, and $84,000 for an entire 12-week course of treatment.
Sovaldi's cost has raised major issues around who will be able to receive the drug in Texas, especially when it comes to those covered by public insurance like Medicaid. The high cost would put a large strain on the state's health systems.
The Texas Health and Human Services Commission has struggled with how to cover the drug. In April, the Commission proposed covering the drug under Medicaid only for those whose Hepatitis had advanced into serious liver damage. That proposal was not approved by the Medicaid drug review board, which suggested revising the proposal to cover more patients whose liver disease was not as advanced.
Despite its incredible potential, the drug's prohibitively expensive cost is making it difficult to provide it to those who need it most.
Find out which Texans are most affected by the drug's potential — and cost — after the jump. About 300,000 Texans have chronic Hepatitis C. The disease is most prevalent among people of African-American or Hispanic descent. The risk factors associated with acquiring Hepatitis C are also associated with poverty, such as intravenous drug use and being in prison. These populations are also more likely to have Medicaid as their primary source of insurance. In Texas, 60% of the Medicaid-covered population is Hispanic, while 16% are African-American. These are the populations who could be positively impacted by Sovaldi, if Medicaid could afford to cover it.
One major population whose needs could be met by the new drug is Texas' prison population. Approximately 45,000 prison inmates in Texas are infected with Hepatitis C. The University of Texas Medical Branch's correctional managed care department oversees prison healthcare, and is in charge of deciding how Sovaldi could be distributed to inmates with Hepatitis C. They are leaning toward only approving the drug for those inmates with the most severe levels of liver damage. Though Sovaldi could hugely improve the health of the many inmates battling Hepatitis C, treating every inmate who has the virus could cost as much as $3 billion.
$3 billion is a cost that would be tough for the Texas correctional system to handle. “It's going to be an interesting challenge for the state just given the fact you have the possibility of potentially, over time, almost eliminating an infectious disease,” Dr. Owen Murray of UTMB's correctional managed care department told the Texas Tribune. Yet because of the cost, starting on the path to eliminating Hepatitis C is not yet an option.
Both public and private insurers alike are starting to take the manufacturer of the drug, Gilead Sciences, to task. Gilead has justified the cost of Sovaldi by arguing that “it will replace even costlier spending on hospital visits and treatments for cirrhosis or liver failure.” But insurers are not taking Gilead's claims lying down. “The company in this case is asking for a blank check and you can't give anyone anymore a blank check because it will blow up family budgets, state Medicaid budgets, employer costs and wreak havoc on the federal debt,” Karen Ignagni, president of America's Health Insurance Plans, told Reuters.
With the costs of research and development, a new drug can cost up to $1 billion to bring to market. Gilead says 30,000 people have already received the new drug, giving them $2.3 billion of sales in the past few months. With numbers like that, it's hard to believe Gilead's claim that $1000 a pill is really a necessary price.
Here in Texas, the Health and Human Services Commission is still working on a revised proposal for covering Sovaldi, which it hopes to get approved by the time the Medicaid drug review board meets again in August. Until then, low-income Texans battling Hepatitis C can only wait and watch as the state determines their future.