Sovaldi-maker Gilead Sciences is making state Medicaid directors an offer they feel they must refuse, said Matt Salo, executive director of the National Association of Medicaid Directors, who spoke Wednesday at a Medicaid conference sponsored by America's Health Insurance Plans.
“When states go to them and say 'Hey, we would like to bring the price [of Sovaldi] down,' they say, 'Sure, we will give you an additional 6% rebate, but only if you open access wide up with no restrictions,” Salo said.
State Medicaid directors thus far have declined the quid pro quo because paying $940 per pill versus $1,000 would still be challenging from a state budget perspective, especially if every Medicaid beneficiary with hepatitis C, including the asymptomatic, had unrestricted access to the drug, Salo said.
A representative from Gilead did not immediately respond to a request for comment.
As of July, all but three states had some prior authorization restrictions in place, Gilead Sciences' CEO John Martin said during a July earnings call. The holdout states did not want to cover Sovaldi until they too could put some standards in place. States generally tend to limit the drug to Medicaid beneficiaries who have begun to experience liver failure.
Martin seemed to champion an end to Medicaid prior authorization requirements during a Morgan Stanley Global Healthcare Conference Sept. 9.
“Your healthcare costs go down over time and the sooner you cure them, the more likely you are to have better long-term outcomes for these patients,” Martin said. “This is exactly the Medicaid population that you want to treat to save that system money over time.”
The Sovaldi offer from Gilead comes at a time when state Medicaid directors are concerned that an asymptomatic hep C-infected individual could sue to overturn a prior authorization requirement, Salo noted.
Follow Virgil Dickson on Twitter: @MHvdickson
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