But in April, a panel for the Department of Veterans Affairs— none of whose members reported financial ties with the drug industry —offered a different take: It suggested doctors use the drugs mostly for patients with advanced liver disease, including those awaiting transplants. The VA panel said most patients at earlier stages of the disease should consider waiting for drugs now in development that may prove superior. Analysts expect those drugs to be available within the next year or two.
Sovaldi and Olysio “should be used because they have a high clinical benefit, but not everyone needs to be treated immediately,” said Rena Fox, a VA panelist and professor of medicine at the University of California at San Francisco.
Recommendations to prioritize treatment for those with advanced liver disease were also made by the California Technology Assessment Forum, a panel sponsored by the Blue Shield of California Foundation that advises insurers, providers and patients.
They noted that drugs expected out as early as this fall may prove superior because they will not require the use of interferon, a drug that can have debilitating side effects.
Even so, Ryan Clary, executive director of the National Viral Hepatitis Roundtable, a patient group, lambastes such limits as "absolutely, rationing." His group, which receives funding from the drug industry, wants the treatments to be broadly available.
"There are plenty of reasons a person with hepatitis C would like to have the virus out of their body," he said. "To say, 'We want you to hold off until you start to get sick,' is really problematic."
Gilead Defends ‘Fair’ Price
The hepatitis drugs are not the most expensive drugs on the market, but their prices are of concern because of the large number of people infected with the virus.
Sovaldi costs $84,000 for a 12-week treatment, although some patients will need to take the drugs for 24 weeks. Olysio is about $66,000 for a 12-week treatment, but is approved for fewer types of patients. Other drugs must often be used with the two new products, adding to the cost.
Drugmakers defend the pricing, saying the treatments are curative, and can prevent the need for other costly care, such as liver transplants.
“Gilead believes that the price of Sovaldi is fair based on the value it represents to a larger number of patients,” Gilead spokeswoman Michele Rest said.
Demand has been strong so far. On April 22, Gilead reported that Sovaldi sales hit $2.3 billion in the first three months of the year, a record-breaking launch for a drug.
Insurers and consumer advocates hope increased competition will result in lower prices for the next round of hepatitis C drugs expected out later this year and next, but that is by no means guaranteed.
Fri, May 02 2014