Over 3 million Americans have Hepatitis C, and 30 percent of them are on Medicaid. The good news is that there’s a new, effective medication called Sovaldi. The bad news is that it costs $1,000 per pill, and state Medicaid programs cannot afford to pay for the treatment. In a recent interview, Jeff Myers, the CEO and president of Medicaid Health Plans of America, said that the situation was a “monumental problem” because the drug could cost $1 billion in the United States during 2014 alone. It’s been estimated that 150 million people worldwide have Hepatitis C. Myers further stated that the cost would challenge the system in 2015.
Myers said that Medicare cannot absorb the $80,000 cost of the three-month treatment. Some states might limit the treatment to only the sickest patients, while others are contemplating a unique financing plan for the drug similar to the AIDS Drug Assistance Program (ADAP) for HIV medications like the protease inhibitor AZT. The cost is particularly bad for states that expanded their Medicare coverage under President Obama’s Affordable Care Act.
Congress and private insurance companies have already criticized Gilead, the manufacturer of the drug, for the price of Sovaldi. United Health Group said that it has spent some $100 million from the Medicare Commercial and Medicare Part D plans that it offers to its customers to pay for treatments. The drug is so expensive due to high research and development costs.
The drug is a true double-edged sword. Many people who have Hepatitis C do not know the “silent killer” lurks within their bodies. As the baby boomer generation ages, more people have discovered that their careless attitude toward sex, drugs and rock and roll has a dark side that’s a ticking time bomb. Hepatitis C is spread by blood to blood contact, such as intravenous drug use, unprotected sex, blood transfusions or organ transplants. It usually remains dormant and percolates for as long as 20 years before it causes liver cancer or liver failure, which forces the patient to undergo a liver transplant. The course of the disease depends on the strain of the virus. Some strains are more aggressive than others.
Over 35 states have contracted with private insurers like Molina, UnitedHealth, Aetna and Centene to run their healthcare programs for poor constituents, but the fate of these plans is uncertain due to the extreme cost. According to the New England Journal of Medicine, some pharmacies are threatening to boycott the drug if the price isn’t reduced.