Dr. Clif CleavelandIn the late 19th century, German physician and scientist Paul Ehrlich popularized the term “magic bullet” to describe his goal of discovering a precise treatment for each infectious disease. From infections to cancer, the pursuit of this goal continues with many dramatic successes along the way.
Earlier this year, I wrote of Sovaldi, a new drug that targets hepatitis C which, in its chronic form, causes liver failure and cancer. It infects an estimated 3.2 million Americans. The virus is transmitted most often by shared intravenous needles, but a small minority of infections may be sexually transmitted. When administered with another anti-viral agent, Sovaldi cures the great majority of persons suffering from hepatitis C. A course of therapy typically costs $84,000.
Health insurance plans already struggled to pay for costly therapies for various malignancies and chronic inflammatory conditions before Sovaldi entered the marketplace. Placing the new drug on its list would force a health plan either to raise premiums or copayments substantially.
Half of all victims of hepatitis C infection depend upon public assistance for their health care. In addition to straining the resources of private health insurance and pharmacy management plans, the disease places an almost unsustainable burden upon Medicaid programs and health care plans for prisoners. An estimated 750,000 Americans with chronic hepatitis C infections depend upon these programs.
A study by Express Scripts, an online pharmacy, estimates that state governments may have to spend up to $55 billion to provide Sovaldi for hepatitis C victims covered by Medicaid programs. For Tennessee, this would cost $1.23 billion ($189 per resident), for Georgia $1.92 billion ($192 per resident), for Alabama $1.1 billion ($227 per resident). California could pay up to $6.68 billion.