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Anthem Strikes Deal With Gilead On Hep C Rx, But Still Restricts Coverage
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Inside Health Policy
John Wilkerson
January 8, 2015
A newly penned deal between Gilead Sciences and Anthem on Harvoni (the third deal on hepatitis C drugs in as many weeks) is far from the last for Gilead, Wall Street analysts say, and the drug maker might strike a deal with Aetna soon. While Anthem is receiving favorable pricing in exchange for being partial to Gilead's product, a company spokesperson said Anthem still restricts coverage of the drug to patients who have advanced liver disease or who are at greatest risk for liver complications. Express Scripts, which in December announced an exclusive formulary agreement for AbbVie's competing Viekira Pak, has no coverage restrictions.
Patient advocates and Medicaid directors are happy that pharmacy benefit managers and insurance companies are getting discounts on the drugs. However, the companies are not disclosing discount amounts so it's difficult for others to determine the significance of the agreements.
"We still don't know if it's really good news or marginally good news," National Association of Medicaid Directors Executive Director Matt Salo said.
Gilead first reached a deal with CVS Caremark, which was reported on Monday (Jan. 5). That deal covered Medicaid formularies, as well as Medicare and commercial plans, and Salo said states that use CVS might be content to let the company get the best price for them. For other states, the agreement opens the door for states to get steeper discounts, he said, although he did not know of states entering negotiations with Gilead or AbbVie just yet. CVS did not respond to questions about whether the pharmacy benefit manager received a discount from Gilead or whether it will restrict coverage of Harvoni.
A spokesperson for Medicaid Health Plans said states will likely continue to struggle with the cost of hepatitis C medications and will have to continue restricting coverage to the sickest patients.
"Our take on the deals is that they're a good first step. We welcome the price competition -- anything that will help bring the prices down. The bad part is, they're starting at such astronomical levels that it's barely going to make a dent." MHPA Director of Marketing and Communications Joe Reblando said.
Lynda Dee, a patient advocate at the Fair Pricing Coalition, said it's better for patients to get Viekira Pak without restrictions than Harvoni with restrictions. Both Viekira Pak and Harvoni showed cure rates above 90 percent in clinical trials, but Harvoni and its predecessor Sovaldi have longer track records and Harvoni is a once-daily drug. Viekira Pak has a more complicated regimen of four to six pills daily and some patients must take it with ribavirin. Ribaviron does not make patients nearly as sick as interferon, which was part of hepatitis C drug regimens for decades until Harvoni was approved. However, it can lower red blood cell counts and fatigue patients.
"It may be easier to take Gilead's one pill once a day Harvoni, but what good is it if your insurance doesn't cover it or has many so restrictions that it is essentially inaccessible unless you have cirrhosis," Dee said. "AbbVie's Viekira has very similar cure rates and should be much more accessible without the appalling prior authorization restrictions."
Jill Becher, a spokesperson for Anthem, said most people don't show signs of hepatitis C infection before being diagnosed, and severe liver damage caused often takes decades to develop and does not occur in everyone who has the disease.
"The newer hepatitis C drugs have been approved through the FDA breakthrough therapy process and tested in far fewer people than typical clinical trials, which means our knowledge is more limited on these drugs. Given the concerns and relative benefits and harms, it made more sense to wait to provide benefit coverage to treat the population with more limited effects of the infection until there has been broader use of the drugs and we know the long-term effects, potential harms and outcomes of the various alternative therapies," Becher said by email.
There will likely be several more deals to come, industry analysts said. Evercore ISI wrote in an investor note that it believes that Aetna, which has a long-term agreement with CVS, will make a deal with Gilead, too. The analysts say it's not clear whether Aetna will make its own formulary decisions or follow CVS' formulary changes. -- John Wilkerson (jwilkerson@iwpnews.com)
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