Fair Pricing Coalition criticises cost of new HCV drugs
The FPC issued this press statement following the announcement of the price of sofosfuvir in the US.
The Fair Pricing Coalition (FPC) today condemned Gilead Sciences for the price set for its direct acting antiviral (DAA) sofosbuvir (Sovaldi), a once-daily, first-in-class nucleotide polymerase inhibitor approved by the U.S. Food and Drug Administration on December 6, 2013, for the treatment of chronic hepatitis C, including those co-infected with HIV.
While FPC believes that all hepatitis C virus (HCV) drugs are priced too high, the coalition of HIV and viral hepatitis treatment activists is especially dismayed by the wholesale acquisition cost (WAC) of $84,000 for a 12-week course of sofosbuvir. For comparison purposes, the FPC notes the 12-week WAC for the recently approved NS3/4A protease inhibitor simeprevir (Olysio) is $66,360.
“Sofosbuvir is a very safe and highly effective drug that will significantly shorten HCV therapy and either reduce or eliminate the need for injected pegylated interferon,” explained FPC Co-Chair Lynda Dee. “However, this does not give Gilead unconscionable pricing carte blanche, particularly when considering that sofosbuvir still needs to be combined with ribavirin for the treatment of HCV genotype 2 for 12 weeks or genotype 3 for 24 weeks. Twelve weeks of therapy with sofosbuvir plus both pegylated interferon and ribavirin is required for the treatment of HCV genotype 1, the most common genotype in the US, and HCV genotype 4.”
The WAC for 12 weeks of HCV treatment with pegylated interferon and ribavirin is approximately $9,000, resulting in a combined WAC of $93,000 for a sofosbuvir -inclusive regimen to effectively treat a single person living with HCV genotypes 1 or 4. To treat HCV genotype 3, 24 weeks of sofosbuvir plus ribavirin is required, resulting in a sofosbuvir WAC of $168,000.
Price Portends an Ominous Future
“Gilead has set the bar dangerously high as other companies determine prices for similar hepatitis C drugs as they enter the market,” Dee said. The effectiveness of sofosbuvir as a component of future pegylated interferon-free regimens for the treatment of HCV will ultimately depend on co-administration with other DAAs currently in development, and are anticipated to come with their own high price tags.
“Sofosbuvir is expected to transform the curative landscape for hundreds of thousands of people living with hepatitis C in the U.S. who require therapy or responded poorly to previous treatment,” said Lorren Sandt, FPC Co-Chair. “Yet the high price will result in significant barriers to treatment access, particularly in limited and fixed-budget programmes, such as Medicare and state Medicaid programmes, AIDS Drug Assistance Programmes, the Veterans Administration, and in correctional systems.”
The high price may also lead to access challenges imposed by private insurance plans and Qualified Health Plans in the new Affordable Care Act (ACA) Marketplaces, notably those with high co-payment and other out-of-pocket requirements.
“There may be reluctance to add sofosbuvir to formularies quickly and payers may force people living with HCV to engage in step therapy in which they are first required to try less expensive options that are less effective,” Sandt added. “These options take longer to complete and are associated with serious side effects, which present a serious impediment to adherence and, ultimately, to being cured of hepatitis C.”
Concessions where they count
Although Gilead refused FPC’s demand for fair pricing of sofosbuvir, the company has agreed to all FPC requests for concessions regarding sofosbuvir access programmes. These include:
- The SupportPath (www.mysupportpath.com) patient assistance programme (PAP), with a $100,000 maximum income allowance for a household of three and 500% of the federal poverty level (FPL) eligibility criteria for larger households.
- The SupportPath sofosbuvir co-pay coupon programme will provide co-pay assistance for eligible patients with private insurance, including ACA Marketplace exchange patients, who need assistance paying for out-of-pocket medication costs. Most patients will pay no more than $5 per co-pay. Co-pay assistance of up to 20% ($16,000) of the WAC price for sofosbuvir can also be applied toward prescription deductibles and co-insurance obligations.
- Gilead has made a contribution to the Patient Access Network (PAN) for co-pay assistance for Medicare Part D clients and has initiated an emergency sofosbuvir supply programme for patients that may lose their prescriptions.
- Gilead has agreed to ensure access to its PAP and co-pay assistance programs for AIDS Drug Assistance Programme (ADAP) patients who are co-infected with HIV, even in states with ADAP programmes that will not include sofosbuvir on their formularies.
The FPC urges Gilead to widely disseminate the details of its SupportPath PAP and co-pay coupon programme, which must include providing written SupportPath information for prescribers, prominently featured SupportPath information in its professional and direct-to-consumer advertisements, and clear links to www.mysupportpath.com via the Gilead and sofosbuvir websites.
FPC press statement. Fair Pricing Coalition condemns Gilead Sciences on the high price of new hepatitis C drug Sovaldi, and urges rapid and wide dissemination of support programme details for uninsured and underinsured people living with hepatitis C. (11 December 2013).