The Senate Committee on Veteran’s Affairs met this week to discuss a silent epidemic that’s haunting millions.
Pharmaceutical giant Gilead, whose recent innovations in Hepatitis C treatment have been lauded as revolutionary by many in the medical profession, refused to testify at the hearing about the exorbitant prices it charges for two new — and highly effective — drug regimens.
"What we are looking at is very excessive profit," said committee chairman Bernie Sanders (I-VT), calling the situation "deplorable" and a "moral issue" that the prices set for the new drug make it inaccessible to most Hep C patients.
— Public Citizen (@Public_Citizen) December 3, 2014
There are at least 130 million people who live with the virus worldwide. It’s also the most common blood-borne infection in the United States, affecting about 3.2 million people here. The virus attacks the liver. It can cause a short-term illness that lasts a few weeks, or can result in a lifelong affliction that leads to chronic liver disease, cirrhosis, and sometimes death.
Veterans are especially hard-hit by the disease. In some VA medical centers, the rates of infection can be as high as 20% of all patients. The highest rate of infection is seen amongst those who served in Vietnam, from 1964 to 1975.
There are a number of reasons why these rates are so high. Research has suggested that soldiers serving in Vietnam were often given blood transfusions post-injury that were not screened for the virus, as the technology was not available. Another risk factor is drug use: by 1971, an estimated 10 to 15 per cent of servicemen had used heroin.
In the past year, the Department of Veterans Affairs has spent $370 million on new treatments for Hep C, and that figure is expected to rise to more than $1 billion over the next two years.
Until recently, the standard for treatment was a cocktail of the drugs interferon and ribavirin, but these produced terrible side effects, like nausea and bacterial infections, and efficacy rates overall were low. The most effective way to cure a chronic hepatitis C infection was via a liver transplant — an expensive and dangerous procedure that’s limited by the number of organs available.
But all that changed last year, when a new drug, developed and manufactured by Gilead, came on the market. It’s called Sovaldi, and used in conjunction with another medication over a 12-week course of treatment, Sovaldi was shown to cure 94% of people with the infection.
But a 12-week course of Sovaldi costs a whopping $84,000 — that works out to $1,000 per pill. It's set to become the highest grossing drug in history.
— Bernie Sanders (@SenSanders) December 3, 2014
“I wish I could say I was optimistic that the future would be different, and prices would moderate,” said Jeff Meyers, the chief executive of the Medicaid Health Plans Association, to vox.com. “But I suspect that’s not the case. What the companies have learned from the Sovaldi experience is that there are precious few ways to manage costs.”
The main reason why Sovaldi is so expensive is because Gilead can effectively dictate its own pricing. Other countries get a better deal because their nationalized health systems offer superior bargaining power — a course of Sovaldi in Egypt, for example, is expected to cost just $900. France recently negotiated a steep discount, meaning that Sovaldi treatment will cost $51,400 — just 60% of the US price.
In the US, the agencies that buy drugs are usually private health plans and public insurance programs. These entities are too fragmented to demand more reasonable prices.
A spokesperson for Gilead told the Wall Street Journal: “pricing is set on a country-by-country basis, agreeing with each government a price that reflects the value of Sovaldi and the needs specific to its health system.”
A newer alternative to Sovaldi is a drug called Harvoni, which was approved by the FDA in October of this year. Harvoni contains Sovaldi, plus another key drug used to fight Hep C. For those looking for a simpler drug regimen, Harvoni might be the ticket. But this newer drug is an even bigger hit on the pocketbook: a course of treatment costs $94,500, which works out to a staggering $1,125 per pill.
New drugs have given hope to Hep C sufferers worldwide. They "hold the promise of eradicating this disease in infected veterans," says Michael Valentino, the VA's chief Pharmacy Benefits Management consultant. But, he said, cost "remains a major challenge."
