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Connecticut is making a new class of hepatitis C
drugs more accessible to those on Medicaid
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State Moves To Make Costly Hepatitis C Drugs More Accessible To Medicaid Patients
May 15 2015
from Jules: Connecticut held hearing May 13 2015
http://www.courant.com/politics/hc-sovaldi-more-accessible-0516-20150515-story.html
HARTFORD - Connecticut is poised to make a new class of costly hepatitis C drugs more accessible to the state's poorest patients.
The state Department of Social Services will classify Sovaldi, Harvoni and Viekira Pak as preferred drugs in its Medicaid program, which means they will be "readily available to our clients,'' said department spokesman David Dearborn.
The department is also simplifying its prior authorization process, which had been criticized by advocates for hepatitis C patients as a tactic designed to limit access to the expensive but highly effective treatments.
"We have streamlined our prior authorization form to a one-page document, for the purpose of supporting increased access, decreased administrative burden on providers and faster treatment,'' Dearborn said.
The changes were outlined Wednesday by the pharmaceutical and therapeutics committee, which helps guide the social services department on Medicaid coverage matters. They will take effect July 1.
Sovaldi and the other new hepatitis C drugs are being praised as breakthrough treatments for the more than 3 million Americans with the disease. But the drugs carry a steep price: about $84,000 per patient for a 12-week regimen, although due to rebates and negotiated discounts from the manufacturer, the state pays about 23 percent less, said Matt Salo, executive director of the National Association of Medicaid Directors, a professional organization for state Medicaid agencies.
Even with those negotiated price breaks, the state and federal governments together have spent more than $90 million on Sovaldi alone for Medicaid patients in Connecticut since July, DSS Commissioner Roderick L. Bremby told legislators earlier this year.
In the 17-month span that ended on April 30, there were 1,736 Connecticut Medicaid clients who received prescriptions for either Sovaldi, Harvoni or Viekira Pak, according to the social services department.
Hepatitis C, which spreads mainly through blood contact, can lead to cirrhosis and liver cancer.
Advocates say as costly as the new drug regimens are, they are curative therapies that will likely save the state significantly more money in the future by eliminating the need for more expensive medical interventions, such as a liver transplant.
"Even though it sounds expensive and it is expensive, [making the drugs more accessible] is ultimately a win-win for taxpayers,'' said Sheldon Toubman, staff attorney at the New Haven Legal Assistance Association.
Salo said increased competition is the biggest reason states are making the hepatitis C drugs easier to get.
"When Solvadi first came on the market, the sticker shock was so significant you saw a lot of, if not all, states pull back and say, 'Wait a minute, we clearly cannot afford to provide this treatment at this price to everybody,''' he said.
Although Medicaid programs are bound by law to provide FDA-approved medications, many states put up barriers to discourage use of costly drugs, such as requiring health care providers to fill out cumbersome prior authorization forms and limiting the medicine to those with end-stage disease. But in recent months, with the introduction of two new drugs - Harvoni, which, like Sovaldi, is manufactured by Gilead Sciences, and Viekira Pak, made by AbbVie - competitive pressures have given states more negotiating room, Salo said.
Connecticut is engaged in negotiations with drug manufacturers that will result in "driving down overall costs, accomplished in part by soliciting favorable rebate offers and by fostering price competition amongst the manufacturers,'' Dearborn said.
That competition is "energizing the competitive market and bringing prices down a lot further,'' Salo said. "States are going to the companies and saying, 'Who will give us the best deal?' What you're seeing in Connecticut pretty closely mirrors what's happening in the rest of the country.''
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