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FAQ: The High Cost of Hepatitis C Drugs

Q: Are these treatments that much better than older ones?

The newer treatments have success rates of 90% or more -- meaning there is no sign of the hepatitis C virus in the body-- compared to success rates of up to 70% for older treatments, Masur says. Some of the new drug treatments wipe out the need to use interferon, which is taken by injection and has unpleasant side effects.

Q: Do any patients pay those total costs out of pocket, or does insurance cover it?

Insurance plans may cover the costs, but also may require copays from patients. "We have had [insurance] approvals for both, with some copays from patients," Carey says. Both drugmakers say they have programs to provide assistance either to reduce the out-of-pocket costs or to provide the drugs at no charge.

Even so, the assistance programs for the new hepatitis C drugs are not, so far, ''as mature, friendly or helpful'' as similar programs for other drugs, Carey says.

Q: Why has the cost of Sovaldi gotten more attention than Olysio?

The focus on Sovaldi is not just because it costs more. Some experts see Sovaldi as the front-runner of the two drugs.

In one analysis, experts favored Sovaldi as the drug with the most potential to increase the number of patients who are virus-free.

Q: Is Sovaldi less expensive outside the U.S.?

Yes, Rest says. In lower-income countries, the company has put ''tiered pricing'' into place, based on the country's gross national income and the number of hepatitis C cases.

Q: What about all the savings in terms of fewer people infected and fewer treatments for chronic infection complications?

From a public health standpoint, reducing the number of infected people is desirable, Masur says. "The more sick people in the population, the higher the hazard to public health," Masur says, since an infected person can spread the virus.

The higher cure rate with the newer oral drugs offers multiple benefits, Carey says. "It runs the gamut, from saving people from the emotional turmoil of hepatitis C to reducing the likelihood of developing cirrhosis, dying of liver failure, or getting liver cancer.''

But, he says, the time it would take for the treatment costs to be offset by the savings in other treatments will probably be lengthy. In one scenario evaluated by the nonprofit Institute for Clinical & Economic Review, analysts say only two-thirds of initial drug costs would be offset by medical savings at the 20-year mark.

Q: What's the future likely to hold, and will prices decline?

Several other hepatitis C drugs are under study, and competition may solve the cost problem, or least improve it. ''To some extent this is probably going to be a self-correcting problem," Carey says. ''Although Gilead and Johnson & Johnson have the corner on the market now, there are plenty of other drugs in development." As those drugs become approved, supply and demand will drive down the costs of the two current drugs.

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