White House urged to stop states' 'rationing' of hep C drugs

Hep C drugs like Gilead Sciences' ($GILD) Sovaldi and AbbVie's ($ABBV) Viekira Pak can cure hepatitis C, preventing people from getting liver disease. But in some states like Illinois, a person on Medicaid can't get Sovaldi unless they already have advanced liver disease. Even then, other restrictions can block them from access to the pricey meds. This kind of rationing is to save money, not lives, and is discriminatory, White House medical advisors have told the administration. Experts have urged a reluctant administration to lay down some consistent guidelines for Medicaid on use of the new drugs.

U.S. President Barack Obama

The Public Health Service and President Obama's Advisory Council on H.I.V./AIDS, have told the administration that restrictions, like barring patients who have been treated for alcohol or drug abuse within 12 months, are not sound medical practice, The New York Times reports. The Centers for Disease Control and Prevention has also expressed concern. They oppose state rules such as requiring patients to have been free of drug or alcohol abuse within 12 months or requiring an infectious disease expert to prescribe the drugs.

Guidelines written by the Infectious Diseases Society of America and the American Association for the Study of Liver Diseases say any patient with chronic hepatitis C should be treated with the new drugs unless they have less than a year to live. Limits by some states are "unreasonable and discriminatory" and are "not supported by medical evidence," the advisory council said in a letter to Mr. Obama, The Times reports. It said the feds need require states to relax if not do away with the restrictions, which end up discriminating against low-income people on Medicaid, the panel said.

"We can cure most patients with as few as 84 pills," Dr. David L. Thomas, of Johns Hopkins University School of Medicine told the newspaper. Thomas helped write the guidelines on use of the hep C drugs. "It's cheaper to treat patients than to wait for them to develop cirrhosis and complications and then get a liver transplant."

But the administration has so far been unwilling to set hard and fast rules, saying it allows states the flexibility to determine how cover the benefits in their states. Officials said the White House has also been sensitive to what impact the pricey drugs are having on the budget since the federal government covers half the cost of the drugs. The panel did not offer suggestions on how to cover the added costs.

When Gilead Sciences first brought Sovaldi to market, it priced it at $1,000 a pill, $84,000 for a 12-week course. Its combo treatment Harvoni is even pricier. But since then, competition from AbbVie's Viekira Pak has led to price cuts. Some efforts have also been made to force the company to lower the price. Matt D. Salo, the executive director of the National Association of Medicaid Directors, told the newspaper he understood that with discounts, the new hep C drugs can now be bought for about $50,000 a person. Each state does its own price negotiating. But he said prices need to come down further to make the meds affordable for everyone that needs them.

Toward that end, the advisory panel also suggested that states disclose what they are paying for the drugs and that the drug companies be required to disclose what it cost them to develop the treatments, something drugmakers are loathe to do.

Some experts see discrimination in policies since hepatitis C is often associated with drug abuse. They say that even at full price, it is a little enough to be paid for a treatment that can cure a disease that kills more people in the U.S. each year than AIDS. "If there were a cure for Alzheimer's or breast cancer that cost $40,000 or $50,000, we would not be having this conversation," said D. Clary, the executive director of the National Viral Hepatitis Roundtable, an association of 250 groups which is working to end the hep C epidemic in the country.

- read the New York Times story (sub. req.)

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