Since before Sovaldi hit the market, Gilead ($GILD) has been justifying its high price with its unprecedented efficacy. While the next-gen hep C treatment costs $84,000 per 12-week course of treatment, it boasts a 90% cure rate--and that's convinced the U.K.'s National Health Service (NHS) to spend £18.7 million ($31.4 million) to fund the treatment for England's sickest patients.
As PharmaPhorum reports, the decision from NHS England will benefit about 500 patients with the most advanced cases of the disease, some of whom are awaiting costly liver transplants. The move follows efforts from a charity, the Hepatitis C Trust, which has been pushing to secure early access to the drug for the neediest patients.
"This is a major step forward for patients with this debilitating, and often life-threatening, disease and is evidence of NHS England's commitment to widen access to cutting edge drugs, treatments and therapies where both clinically appropriate and cost effective," James Palmer, NHS England's clinical director of specialized services, said in a statement.
It could be a break for Gilead, whose drug's efficacy has so far secured it pricing power without a true rival on the market. Sovaldi is not yet approved by the U.K.'s National Institute for Health and Care Excellence (NICE), a cost-effectiveness gatekeeper that often presses drugmakers to offer discounts in order to be approved.
Without any such system in place in the U.S., payers have been searching for their own ways to lower Sovaldi's costs, which they say pose a significant risk to their budgets or bottom lines. Some Medicaid health plans have demanded states' help in paying for the drug; Molina Healthcare, for one, has requested direct reimbursements for Sovaldi beyond its contracted rates in the 11 states in which it covers patients. And last month, a California panel recommended a move similar to NHS England's, prioritizing the sickest patients for Sovaldi treatment.
But the most radical so far has been Express Scripts ($ESRX). After consulting doctors on whether some of its hep C patients could wait until competitors arrived to tamp down costs, the PBM earlier this month began assembling an anti-Sovaldi coalition to shut the drug out until those challengers hit the market.
- get more from PharmaPhorum
Special Report: The FDA's drug approvals of 2013 - Sovaldi: Gilead hits pay dirt with a breakthrough hep C drug