The staggering cost of Sovaldi, the $1,000-a-pill treatment for hepatitis C, is prompting serious discussions among healthcare leaders about the price tags of potentially life-saving specialty drugs and whether the government should regulate those prices.
“The Sovaldi example has brought us to a crossroads,” Karen Ignagni, president and CEO of the trade industry group America's Health Insurance Plans, said during a healthcare forum last week in Washington. “We need to sit together to begin talking about how we can attack this problem together before the government has to. … We cannot sustain six-figure therapies, and we're at the beginning of that trend.”
Ignagni's comments came during a forum sponsored by the Atlantic magazine titled “Future of Medicine: A Conversation on Cost and Value.” It focused heavily on Sovaldi, manufactured by Gilead Sciences, whose high cost is vexing private insurers, Medicaid and Medicare officials, and patients diagnosed with the chronic liver disease.
Sovaldi has proven remarkably effective in combating the hepatitis C virus, with a reported cure rate of more than 80%. But a full 12-week course of treatment costs $84,000.
That's causing insurers and public health officials to engage in difficult financial and ethical discussions about who should be entitled to access the drug. Medicaid managed-care insurers are asking state Medicaid agencies to pay for Sovaldi over and above the capitation rate paid to plans or else build Sovaldi costs into their rates. Most advanced countries regulate the price of drugs.
Meanwhile, the American Society of Clinical Oncology is developing an algorithm to rate the cost-effectiveness of expensive cancer drugs and is encouraging doctors to discuss costs with their patients. Taking the cost benefit of therapies into consideration has long been hugely controversial in U.S. medicine and politics.