Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

How hepatitis C treatment is a glimpse of health care’s future

Kevin R. Campbell, MD
Meds
May 22, 2015
Share
Tweet
Share

Hepatitis C is one of the most common chronic infectious illnesses in the U.S. today and affects nearly 3.2 million Americans. Complications of hepatitis C infection include liver cancer as well as cirrhosis.  Many patients with chronic hepatitis ultimately develop liver failure and will die without liver transplantation.  In the last year,  a new drug class has entered the market and can produce cure rates in excess of 90 percent.

These drugs — Sovaldi and Harvoni — are incredibly expensive, and some treatment courses cost more than $1000 a day.  Typical treatment courses to achieve cure require 12 weeks of continuous treatment.  Drug maker Gilead reported that sales of Sovaldi exceeded 2.2 billion dollars in the first quarter of 2015. According to a report released by Express Scripts in 2014, spending on hepatitis C therapy increased by 700 percent between 2013 and 2014.  In fact, only 1 percent of drugs accounted for 32 percent of spending over the same time period — much of this is due to the emergence of the new treatments for hepatitis.

When questioned about the cost of the drug, most pharmaceutical executives will claim that the cost is justified by the investment of time and money in research and development that led to the cure.  The cost to take a drug to market and obtain FDA approval is great but does it really justify the astronomical costs?

But aren’t they simply charging what the market will bear?

Gilead executive Gregg Alton argues that the pricing of their drug is based on what they think is a “fair price for the value that [we] are bringing into the health care system and to [the] patients.”  Will the price be lowered once investment is recouped?  Alton thinks this scenario is “very unlikely.”

What are the implications for Medicare?  Who will get the drug and who pays the bills?

The Washington Post reports that Medicare spending on hepatitis C therapy exceeded 14.5 billion dollars last year alone.  Nearly 350,000 Medicare beneficiaries have hepatitis C (and many are not even aware of their diagnosis) according to an analysis by Health Affairs published last year.  By law, Medicare is prohibited from negotiating prices with pharmaceutical suppliers.  Taxpayers will bear the brunt of the cost — once a Medicare recipient reaches 4,700 dollars out of pocket, the government program’s “catastrophic” coverage will then pick up the bulk of the remaining tab.

Ultimately, other Medicare patients will have higher deductibles and continued “cost sharing” will result in higher costs for everyone.  My fear is that widespread rationing may be implemented, and access to a life-saving drug may be ultimately limited due to overwhelming costs.  Medicaid is already beginning to ration use in many states and the Senate Veterans Affairs Committee has held hearings in the last year in order to question industry about the price point and to prepare to address how the national VA Hospital system will deal with the exorbitant costs of the therapy.

It all goes back to reform

Health care costs continue to rise — even with reform.  The Affordable Care Act is clearly short-sighted, and laser focused on only certain aspects of health care costs.  The legislation has addressed limiting costs thru declining payments to doctors and health care systems.  Access to physicians, particular health care centers, and certain treatments is tightly controlled and, in some cases, severely limited.  The ACA does nothing to address the other TWO major root causes of skyrocketing health care expenditures: cost of drugs/therapy as well as medical liability and lawsuits.

Until the U.S. adopts a national policy of tort reform (which is unlikely to happen given the power of the trial lawyer lobby in Congress) as well as price controls on expensive drugs such as the biologics for Hepatitis C, nothing will change.  Ultimately, the costs of these life-saving drugs must be addressed.  If we continue in the current system, the money for these therapies will have to be carefully adjudicated.  The hints of rationing in health care are already here — Medicaid and the VA system — a “model” for socialized medicine are already addressing ways in which they can adjudicate dollars to treat the most severe cases of hepatitis C.

I expect that eventually we will see waiting lists for therapy and policies put in place to determine which patients will be eligible to receive higher priced drugs. Innovation is expensive and pharmaceutical companies and entrepreneurs should be rewarded for their investment and their risk — but, we must also balance the reward with what is reasonable and affordable for all patients seeking a cure for a potentially deadly disease.

Kevin R. Campbell is a cardiac electrophysiologist who blogs at his self-titled site, Dr. Kevin R. Campbell, MD. He is the author of Women and Cardiovascular Disease.

Prev

When medical journals disagree: What's a practicing physician to do?

May 22, 2015 Kevin 2
…
Next

MKSAP: 25-year-old woman is evaluated for redness at mosquito bite

May 23, 2015 Kevin 0
…

ADVERTISEMENT

Tagged as: Gastroenterology, Medications

Post navigation

< Previous Post
When medical journals disagree: What's a practicing physician to do?
Next Post >
MKSAP: 25-year-old woman is evaluated for redness at mosquito bite

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Kevin R. Campbell, MD

  • Is there a PBM mafia?

    Kevin R. Campbell, MD
  • This South Pacific island will change how you think about health care

    Kevin R. Campbell, MD
  • How Twitter is a vital tool in medicine

    Kevin R. Campbell, MD

More in Meds

  • Why retail pharmacies are the future of diverse clinical trials

    Shelli Pavone
  • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

    Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO
  • A world without antidepressants: What could possibly go wrong?

    Tomi Mitchell, MD
  • The truth about GLP-1 medications for weight loss: What every patient should know

    Nisha Kuruvadi, DO
  • The hidden bias in how we treat chronic pain

    Richard A. Lawhern, PhD
  • Biologics are not small molecules: the case for pre-allergy testing in an era of immune-based therapies

    Robert Trent
  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Why male fertility needs to be part of every health conversation

      Hoag Memorial Hospital Presbyterian | Conditions
    • How a rainy walk helped an oncologist rediscover joy and bravery

      Dr. Damane Zehra | Physician
    • Inside human trafficking: a guide to recognizing and preventing it [PODCAST]

      The Podcast by KevinMD | Podcast
    • Graduating from medical school without family: a story of strength and survival

      Anonymous | Education
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
  • Recent Posts

    • How a rainy walk helped an oncologist rediscover joy and bravery

      Dr. Damane Zehra | Physician
    • How inspiration and family stories shape our most meaningful moments

      Arthur Lazarus, MD, MBA | Physician
    • A day in the life of a WHO public health professional in Meghalaya, India

      Dr. Poulami Mazumder | Physician
    • Why women doctors are still mistaken for nurses

      Emma Fenske, DO | Physician
    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast
    • Adriana Smith’s story: a medical tragedy under heartbeat laws

      Nicole M. King, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 43 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Why male fertility needs to be part of every health conversation

      Hoag Memorial Hospital Presbyterian | Conditions
    • How a rainy walk helped an oncologist rediscover joy and bravery

      Dr. Damane Zehra | Physician
    • Inside human trafficking: a guide to recognizing and preventing it [PODCAST]

      The Podcast by KevinMD | Podcast
    • Graduating from medical school without family: a story of strength and survival

      Anonymous | Education
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
  • Recent Posts

    • How a rainy walk helped an oncologist rediscover joy and bravery

      Dr. Damane Zehra | Physician
    • How inspiration and family stories shape our most meaningful moments

      Arthur Lazarus, MD, MBA | Physician
    • A day in the life of a WHO public health professional in Meghalaya, India

      Dr. Poulami Mazumder | Physician
    • Why women doctors are still mistaken for nurses

      Emma Fenske, DO | Physician
    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast
    • Adriana Smith’s story: a medical tragedy under heartbeat laws

      Nicole M. King, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

How hepatitis C treatment is a glimpse of health care’s future
43 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...