Commentary

Express Scripts Will Offer AbbVie's Hep C Treatment, Excluding Gilead's Sovaldi

After gaining approval from the Food and Drug Administration on Friday, AbbVie’s new hepatitis C treatment, Viekira Pak, got a marketing boost today with Express Scripts announcing it has negotiated a significant discount for the regimen that is effective for the most common strain of the liver disease and would offer it exclusively to 25 million consumers covered under its National Preferred Formulary.

“The wholesale ‘sticker’ price for Viekira Pak is $83,319 per patient for a 12-week treatment regimen,” reports the Boston Globe’s Robert Weisman — “slightly less than the best-selling hepatitis C medicine, Sovaldi,” a Gilead Sciences treatment that has been under fire for its “$1,000 a pill” price tag since it came on the market in late 2013.

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Still, Sovaldi has been setting sales records, and Gilead gained approval from the FDA in October for a new treatment — Harvoni — that is a more direct competitor to Viekira Pak. Both are interferon-free treatments for most genotype 1 patients, who make up 70% of the market, as Investor Business Daily’s Amy Reeves reports.

Andrew Pollack calls Express Script’s announcement a “sign that price competition may take hold for hepatitis C drugs,” in his lede in the New York Times.

“We really believe we want all patients treated,” AbbVie chief medical officer Dr. Steve Miller tells Pollack.

Miller “would not disclose the discounts AbbVie is providing but said it would significantly narrow the gap between prices charged in the United States and Western Europe. Sovaldi has been selling for $50,000 to $70,000 in some European countries,” Pollack reports.

In the statement announcing the deal, Miller says:  “Pharmaceutical innovation must be rewarded based on the value it brings to patients and payers. This agreement marks a fundamental change in how sustainable access and affordability will be delivered to hepatitis C patients.”

“Sovaldi and Harvoni, as well as Johnson & Johnson’s Olysio, will be excluded from the National Preferred Formulary, though patients who've already begun treatment before Jan. 1 will continue to receive coverage,” reports CNBC’s Meg Tirrell. “Sovaldi will remain on the formulary for patients with other kinds of the virus who have advanced liver disease, Express Scripts said.”

“Express Scripts’ move also highlights the growing role of [Pharmacy Benefit Managers] in health-care decision-making. Express Scripts and other PBMs like CVS Health Corp. can influence the drugs patients receive by decreasing co-payments for preferred treatments or by excluding competing drugs altogether, as in the case of Gilead’s Harvoni and Sovaldi,” Joseph Walker writes in the Wall Street Journal.

“Gilead has said the prices are justified because the new generation of drugs represent a significant medical advance for patients, with high cure rates,” Walker points out.” And treating hepatitis C, which can cause liver cancer, is cheaper in the long run and avoids more costly care like liver transplants.”

The Centers for Disease Control estimates that 3.2 million persons in the U.S. have chronic Hepatitis C virus infection but most are unaware of it “because they don’t look or feel sick.” It is a contagious disease “that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness that attacks the liver,” and may result in “cirrhosis (scarring of the liver) or liver cancer,” according to the CDC.

Due its price, only patients who had advanced liver disease had access to Sovaldi, which has a 95% cure rate, Samantha Liss reports in the St. Louis Post-Dispatch.

“This is huge,” Express Script’s Miller tells Liss. “In the last year, plan sponsors have had to, by necessity, prioritize patients and only treat those with the most severe disease. We are at a threshold of being able to eradicate hep C in the United States.”

We likely are also on the threshold of PBMs asserting even more influence over pricing.

“If the specialty drug trend continues to increase by double-digit percentages, payers will be forced to implement even more narrow management tools, thus limiting the number of patients who can afford to receive the drug therapy,” Paula Jakub, CEO/EVP of American Foreign Service Protective Association, says in Express Script’s statement announcing the deal. “It only makes sense for manufacturers to work with payers on pricing decisions.”

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