Panel to rule pricey hep C meds cost-effective, endangering payer pushback

Payers continue to grouse about the cost of hepatitis C fighters from Gilead Sciences ($GILD) and AbbVie ($ABBV), as more and more patients seek treatment with the pricey meds. But as Bloomberg reports, a forthcoming analysis could throw a big wrench into some insurers' ongoing efforts to limit access to the drugs.

At their currently discounted prices, the Gilead and AbbVie drugs are cost-effective, according to a panel of doctors and experts assembled by the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA).

And that's not only for the sickest patients, which on some health plans are the only ones guaranteed access to Gilead's Harvoni and Sovaldi, and AbbVie's Viekira Pak. It's for patients whose livers haven't yet entered the damaged zone that would qualify them for the restricted coverage.

"If you look at the catalog price, which is like the sticker price on the car, no one actually pays that," Dr. Benjamin Linas, a panel member, told the news service. "The more realistic, actual cost, the price people are paying--it's in the cost-effective zone."

Analysts have estimated discounts at 40% or so, since Viekira Pak's appearance on the scene triggered a pricing war between AbbVie and the first-to-market Gilead. Even with some insurers trying to limit access to the meds, scripts for hep C meds have more than doubled to 48,000 for the first quarter of 2015, compared with 20,600 for the same period of 2014, according to IMS Health data cited by the Associated Press.

The panel's report will be the latest version of treatment guidelines for the disease. As Bloomberg notes, previous guidelines on use of the new generation of hep C treatments didn't mention cost-effectiveness at all. Backing from the panel on this score could potentially help doctors and patients make their case for insurance coverage.

Gilead has defended its pricing on Harvoni--list price $1,350 per day--and Sovaldi by citing the enormous cost of liver transplants, a long-term complication of hepatitis C. Upfront use of the drugs also prevents costly hospitalizations, Gilead maintains.

Lawsuits could be a side effect of the report from AASLD and IDSA, one source told Bloomberg. With that sort of backing on cost-effectiveness, more patients could sue their insurers for coverage. One Anthem Blue Cross patient in California has already done just that after trying and failing to get access to Gilead's Harvoni.

- read the Bloomberg news

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