Cost of Hepatitis Drug Raises Questions About Access

A new treatment for hepatitis C is considered a breakthrough for people with the liver disease. But the high cost of the drug — about $1,000 a pill — has complicated efforts to get the medication to Texans who receive government-subsidized health care.

The state’s prison system and the taxpayer-funded Medicaid program, which covers poor children and people with disabilities, are trying to determine who qualifies for the drug, which is 80 to 90 percent effective but can cost $84,000 for a 12-week regimen.

In Texas, where roughly 300,000 people have chronic hepatitis C and many more may carry the virus, the treatment has raised ethical questions about who gets the drug.

In April, the Texas Health and Human Services Commission proposed that Medicaid cover the treatment, called Sovaldi, for patients who were already suffering from liver damage. The Medicaid drug review board did not approve that criteria; instead, it directed the commission to revise its proposal so that it was similar to what “other reputable groups were recommending,” said Stephanie Goodman, a spokeswoman for the Texas commission. Those recommendations include covering the drug for certain patients with less advanced liver damage.

The commission is revising its proposal and hopes to get board approval ahead of its August meeting so the treatment can be covered by the fall. If it is unable to do so, Medicaid patients are unlikely to be able to obtain the treatment through Medicaid until January, Goodman said.

In the fiscal year that ended in August, the state spent $12 million treating Medicaid patients with hepatitis C. The health commission was unable to provide an estimate of how much that amount would grow with the new treatment.

The University of Texas Medical Branch’s correctional managed care department, which oversees inmates’ medical services, has been charged with recommending how and when the new drug is used in state prisons. Inmates are particularly prone to the disease; an estimated 45,000 in Texas are infected.

If the treatment is approved, Sovaldi could become the hepatitis drug of choice for the state’s prison population, said Dr. Owen Murray, the vice president for the correctional managed care program. But he added that because of the drug’s cost, it could be prioritized among inmates who have a particular degree of liver damage — an effort to be “clinically and fiscally responsible.”

“The cost of that cure is obviously significant,” Murray said. “It’s going to be an interesting challenge for the state just given the fact you have the possibility of potentially, over time, almost eliminating an infectious disease.”

Last year, treatment for hepatitis C among inmates cost the state about $2 million — a figure Murray said was low because many patients chose to delay treatment knowing that new drugs were coming. Murray estimated that treating every inmate who may carry the virus with the new drug could cost up to $3 billion.

Consumer advocates fear the cost could keep some patients, particularly those who depend on public health coverage, from benefiting. In an effort to pressure the drug maker, Gilead Sciences, to lower the price, some medical organizations have asked state Medicaid programs not to provide Sovaldi yet.

Anne Dunkelberg, associate director of the liberal Center for Public Policy Priorities, said the new hepatitis C treatment puts in “sharp focus” the ethical questions behind administering effective but expensive drugs.

“The question is whether as a society we have an obligation to make lifesaving drugs and technology available to everyone at a price they can actually access,” Dunkelberg said.

Disclosure: The University of Texas Medical Branch was a corporate sponsor of The Texas Tribune in 2012. A complete list of Texas Tribune donors and sponsors can be viewed here.

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.