Sovaldi payer pushback hurting access for opioid treatment patients

Gilead's Sovaldi--Courtesy of Gilead

Ever since the launch of $84,000-per-treatment-course Sovaldi, payers have been getting creative as they look for ways to minimize the damage of Gilead's ($GILD) hep C wonder drug to their budgets and bottom lines. Now, some are balking at covering the med for those enrolled in opioid treatment programs.

It's not because the drug has proven unsafe for those patients, The Wall Street Journal's Pharmalot reports. And Sovaldi's overall cure rate stands at about 90%. But some payers are worried that this population won't keep up with their meds, squandering treatment dollars that could go toward healing other patients.

On the contrary, opioid treatment programs have the unique ability to provide hep C testing and treatment since they're required to oversee medical care, argues Elinore McCance-Katz, chief medical officer for the U.S. Substance Abuse and Mental Health Services Administration. Sovaldi is "so important in terms of morbidity and mortality," she told the blog.

The FDA has also indicated that Sovaldi can be given with methadone to patients in opioid treatment programs without having to make any dosing adjustments, Pharmalot notes. But some payers, desperately seeking ways to limit the drug's use, are still skeptical, claiming Sovaldi hasn't been studied sufficiently in that patient pool.

Over the past several months, payers have made a wide range of moves to curb Sovaldi spending, from seeking to restrict use of the drug to the sickest patients, to--in the case of PBM Express Scripts--rallying a coalition to shut Sovaldi out until competitors hit the market and drive prices down. While Gilead execs have argued that paying for the drug now is cheaper than paying for hep C treatment and its associated complications down the line, the sheer volume of chronically infected Americans--which stands at around 3.2 million--has payers overwhelmed.

And that may still be the case once competition does arrive, some have predicted. Gilead is waiting for FDA approval on a combo hep C regimen containing Sovaldi, with other drugmakers--like AbbVie ($ABBV) and Bristol-Myers Squibb ($BMY)--on track to bring their rival cocktails to market as well. None, however, has so far indicated that their prices will be any more payer-friendly than Gilead's, and Sovaldi's record-breaking success--the drug has pulled in $5.8 billion through the first 6 months of 2014--may have them wanting a piece of the action.

- see the Pharmalot story

Special Report: The New Drug Approvals of 2013 - Sovaldi