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Health Care Reform:

Health Insurance & Affordable Care Act

Medicare Reverses Denial Of Costly Treatment For Hepatitis C Patient


One of them, called Sovaldi, costs $84,000 for a typical 12-week course of treatment, although some patients will need to take the drugs for 24 weeks. The other, Olysio, costs about $66,000, but is approved for fewer types of patients. Other drugs must often be used with the two new products, adding to the cost.

The issue of paying for the expensive new drugs – which may cure upwards of 90 percent of patients — is being closely watched by patient advocates, federal health and budget officials, state Medicaid directors, the Department of Veterans Affairs, and corrections officials across the country. All face billions of dollars in potential obligations to treat the three to five million Americans infected by the deadly virus.

The publication Inside CMS has reported that Gilead Sciences, maker of Sovaldi, gained 90 percent of the $2.1 billion first-quarter sales of the drug – a record for any new drug – from Medicare and private health insurers. Another 7 percent of sales came from Medicaid.

Medicare officials’ fast response in the Bianco case is an indication of the political sensitivity of rejecting potentially life-saving coverage based at least in part on the drugs’ costs. “We want to try to be as helpful as we can to get beneficiaries the drugs that they need,” a Medicare spokesman said earlier this week.

Or to put it the other way around, no one wants to be the first to say that patients who need the drugs can’t get them– in other words, that hepatitis C has pushed the nation into explicit rationing of life-saving care.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Thu, May 15 2014

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