Are medical practices waiting too long for costly Hepatitis C treatments?

Written by Alyssa Clark

The pricing war has caused health insurers, medical practices and patients to band together to demand better access to these life-saving drugs.

Drugs from Sovaldi and Olysio are now offering promising solutions for those suffering from hepatitis C, however the recently released lifesavers can cost upwards of $1,000 per pill. This cost has caused rippling results for taxpayers and healthcare providers alike, because when patient costs go up, so does the need for patient financial aid, government health programs and providers’ purchasing expenses.  This “waiting game” is not only irresponsible to protecting public health, but causes unwarranted pressure on medical practices and businesses as an entire unit:

“The price makes it very hard for the healthcare system,” said Steve Pearson, who oversaw the meeting Monday for the California Technology Assessment Forum, a group affiliated with health insurers that holds public meetings to weigh evidence on new treatments.

The system as a whole entity is being affected by this pricing-spike; it’s not only the patients who are affronted with outrageous out-of-pocket charges. Until recently, therapies for hepatitis C were only 50 percent successful in treating patients and housed numerous side effects such as flu-like symptoms, anemia and even depression. With the recently released drugs from Sovaldi and Olysio, cure rates are proven to skyrocket to the 80th and 90th percentile and will present users with fewer amounts of uncomfortable or harmful side effects.

The only thing holding back patients from receiving these revolutionary drugs is the price. On top of patients facing the immediate burden of the out-of-pocket costs, providers are feeling the financial-heat from the spike as well. Medi-Cal insurers, private practices and corporate healthcare businesses are all sensitive to the hep C pricing and are worrisome of an expensive trend sparking in the industry:

“I can’t imagine how that would be feasible without bankrupting our system,” said Rena K. Fox, a professor of medicine at the University of California, San Francisco, invited by the forum to speak as an outside expert.

“What I really wish for is that we could push back on the price, rather than make patients wait. But since we don’t have the ability to change the price, we have to decide which patients are the most urgent.”

Making both patients and providers wait until the pricing battle ceases not only puts patients’ lives in danger, but causes providers to continue to prescribe these 40 percent effective treatments, when a 90 percent effective treatment exists within reach. In addition to these already unfortunate circumstances, physicians have to now decide “who deserves the drug most”, forcing those sick patients to wait until their conditions worsens enough to make it onto the pre-approved list.  

Although pharma giants like Johnson & Johnson, Sovaldi, Gilead and others work with government health programs and low-income patients, employers and health insurers are worried that these are only the first to come of these high-priced specialty drugs, and what the healthcare industry will begin to look like as a result of this expensive pharmaceutical drug-market.