| |
Hepatitis C drugs top Medicaid spending, highlighting larger concerns
|
| |
| |
"Harvoni, made by Gilead, accounted for the majority of hepatitis C spending. The sticker price for one course of treatment is $94,500 though New York's Medicaid program, like others around the country, receives a steep discount from the manufacturer and pays closer to $28,000 per prescription."
From Jules: Yesterday at the HCV Summit Jason Helgerson who heads up NYS Medicaid & Medicare said his drugrefi,endcost $68k, NOT TRUE. He did saythat was his full retail cost but did not ay his real cost after rebates. And the figure he quoted of overall cost of $650 million for HCV drugs as well did not include rebates. NYS should not be allowed to get away with such comments, but he was not challenged on this.
By Dan Goldberg
03/08/16
http://www.politico.com/states/new-york/albany/story/2016/03/hepatitis-c-drugs-top-medicaid-spending-highlighting-larger-concerns-000000
New York State spent at least $107 million on hepatitis C drugs during the third quarter of 2015, accounting for roughly 10 percent of all Medicaid drug spending.
That takes the total spent on hepatitis C drugs to more than $400 million through the first nine months of last year, emphasizing just how much strain the disease and a few other blockbuster drugs are putting on the state's insurance program for low-income residents.
The dollar figure may even be low as reporting to the federal government often lags.
New York's conundrum isn't unique and Medicaid officials here, as in other states, have publicly bemoaned pharmacy costs. Gov. Andrew Cuomo's budgetseeks to cap certain drug pricing while requiring unprecedented disclosure from pharmaceutical companies.
Harvoni, made by Gilead, accounted for the majority of hepatitis C spending. The sticker price for one course of treatment is $94,500 though New York's Medicaid program, like others around the country, receives a steep discount from the manufacturer and pays closer to $28,000 per prescription.
The addition of new drugs such as Viekira Pak, made by AbbVie, reduced the cost per patient by 18 percent between 2014 and 2015, according to the state health department.
Harvoni came on the market at the end of 2014, a break through drug that followed Sovaldi, also made by Gilead, which was able to cure hepatitis C, a virus that is often transmitted through intravenous drug use and can cause liver failure. The state health department estimates that about 200,000 New Yorkers are infected.
The enormous upfront investment Medicaid is making should pay dividends in the future as thousands fewer people require dialysis or liver transplants.
Harvoni is far from the only drug straining New York's Medicaid budget.
Truvada, the pre-exposure prophylactic that prevents HIV transmission, cost the state's Medicaid program more than $124 million, and accounted for roughly 3 percent of Medicaid drug spending through the first nine months of 2015.
It was the second-most expensive drug in the Medicaid program.
The Cuomo administration has highlighted the importance of increasing access to Truvada as it works to end the HIV/AIDS epidemic by 2020.
If the administration is successful, costs for other antiretroviral medications such as Atripla, which cost Medicaid $93 million through the first nine months of 2015, would begin to decline.
The long-term benefits, whatever they may be, do nothing to address the short-term budget realities.
"We really think pharmacy is a major challenge to us," Jason Helgerson, the state's Medicaid director, said in January. "It is the fastest growing part of the Medicaid program."
Pharmacy expenditures are growing at about $1 billion per year, he said.
Cuomo has proposed that the state health commissioner be allowed to create a list of prescription drugs "for which there is a significant public interest in ensuring rational pricing by drug manufacturers."
The manufacturers of the drugs on the list would then be required to provide a minimum rebate to Medicaid, which would be set by the state following an actuarial study.
Cuomo's budget briefing book lamented that certain drugs are so expensive "it becomes difficult to offer the drug to all Medicaid patients who could potentially benefit from it."
Harvoni, for example, is rationed in New York and several other states, and reserved for only the sickest patients, a policy denounced by advocates who say it is unjust to make someone wait to become even sicker before offering them a cure.
Lawyers in Washington are suing that state's Medicaid program and two commercial insurers, claiming restrictions to the hepatitis C medications are unlawful, and many expect more lawsuits to be filed in the coming months.
"By charging tens of thousands of dollars for hepatitis C drugs that cost hundreds to make, companies like Gilead bear ultimate responsibility for sickness and death among patients who can't get access," said Matt Curtis, director of policy and program for VOCAL-NY, an advocacy group. "But the insurance coverage restrictions imposed by New York Medicaid and others are illegal and unethical. We share the desire to reduce health care costs, but not at the expense of New York's most vulnerable."
|
|
| |
| |
|
|
|
