A new drug becomes the only option for some patients

Dan Weissmann Dec 22, 2014

A newly-approved drug for Hepatitis C will be the only treatment covered for many patients whose employers use a company called Express Scripts for their pharmacy benefits.

Last year, Gilead Sciences Inc. introduced a highly-effective hepatitis C drug, with an $84,000 price tag. Those kinds of prices have been more common for drugs treating conditions so rare they are sometimes called “orphan diseases.” Hepatitis C, on the other hand, affects more than three million people.

“These were orphan-drug prices for common diseases,” says Steve Miller, chief medical officer for Express Scripts. “That’s just not sustainable.”

The sticker price on the new drug, from AbbVie Inc., is just a tiny bit cheaper— $83,319— but Express Scripts has negotiated a discount.

The company says patients will benefit through expanded access to the drug, which has generally only been covered for people with advanced stages of the disease. 

On the other hand, the new arrangement limits treatment options for patients. It’s too soon to tell whether that downside will be significant, says Jack Hoadley, a research professor with Georgetown University’s Health Policy Institute. AbbVie’s drug was approved on December 19, just days before the Express Scripts deal was announced.  

“This drug is so recently approved we’re only going to be learning over time whether there are some patients this drug doesn’t work as well for,” says Hoadley.

Express Scripts covers about 25 million people directly. It also administers drug benefits for another 65 million through health insurance plans.  

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