WILSONVILLE, Ore. — An Oregon Medicaid committee on Thursday significantly scaled back access to an effective — but expensive — new drug used to treat hepatitis C.
The decision allows only a narrow set of Medicaid patients to be treated with the $1,000-per-pill drug known as Sovaldi, made by Gilead Sciences Inc.
Medical experts on Oregon’s pharmaceutical review committee question whether the drug is worth the price tag, and officials worry it would break the bank. They say treating all Medicaid patients with the liver-wasting disease would cost almost as much as last year’s entire drug bill.
Oregon’s guidelines would allow the drug to be used only for patients with later stages of liver damage who have been drug-free for at least six months. The drug could only be prescribed by a liver or gastrointestinal specialist, which often requires months of waiting for an appointment.
The moved drew an angry reaction from hepatitis patients and groups that work with them. Lorren Sandt, director of Caring Ambassadors, a hepatitis C resource group based in Oregon City, called the guidelines “horrific.”
“Can you imagine if you were a cancer patient and they said, ‘We’re going to wait until you’re Stage 4 before we’ll treat you?’ ” Sandt told The Associated Press. “That’s what they’re doing.”
Allowing liver damage to advance to late stages puts patients at a high risk for cancer and lowers their quality of life, she said.
The cost of a 12-week regimen of Sovaldi along with two companion medications that patients must also take is around $100,000. Competing regimens with other drugs cost in the mid- to high five figures, and some are far less effective.
Oregon took up the issue a day after Illinois’ Medicaid program put in place tight restrictions on the use of the drug, including requiring patients to meet 25 criteria and get prior approval before the government will pay.
A separate Oregon panel could go even further next month, removing Sovaldi from the list of treatments covered under Medicaid and requiring doctors to make an individualized appeal to obtain the coverage. Oregon can take such a strong stance because of a federal waiver that allows the state to prioritize treatments for medical conditions based on their cost-effectiveness.
Tom Burns, director of pharmacy programs at the Oregon Health Authority, said it’s impossible to know how many patients will make it over the hurdles officials are establishing.
Hepatitis develops slowly over years or decades. Oregon officials say that while they wait for the price to drop or for new treatments to come on the market, they want the drug available only to those who face imminent severe liver problems.
