QUESTION: Sovaldi is a new Hepatitis-C drug that is remarkably effective with a 90% cure rate. In comparison, existing medications have roughly a 50% effective rate. The problem is that Sovaldi is also remarkably expensive, $1,000 a pill with a typical 12-week, 84-pill course. As a hospital, should we add Sovaldi to our approved medications list?
ANSWER: Whether it’s called appropriate use of resources, having to put limits on health care spending, or health care rationing, this is an issue that can’t be avoided, and it will come up with expensive medications yet to come. And, no, it is not fair when some people can afford Sovaldi or the platinum health insurance that will pay for it, while others cannot. Of course, there are ethical issues involved. In some ways, this is an issue to be addressed by a hospital’s ethics committee as much as a pharmacology committee or a committee that addresses purchases of medical devices, drugs and inventory (and so their costs).
A recent article in Modern Healthcare stated that the drugs Sovaldi and Olyio are projected to cost Medicare up to $5.8 billion in 2015. The Illinois Department of Health Care and Family Services (DOH) went on record as to its own decision-making concerning Sovaldi and its Medicaid coverage. As per the DOH, in 2013, Illinois spent $6.7 million for all of its Hep-C therapies. In the first six months of 2014, Illinois spent more than $16 million on Sovaldi.
The DOH established 25 criteria that have to be met in order for Illinois to fund the use of Sovaldi. As described by the DOH Medical Director: “I am torn. On the one hand, I recognize that everybody should be able to get reasonable medical services without thinking of cost when they are sick. Life is much more precious than that. On the other hand, if we decide that the cost does not matter because someone else is paying for it, then we’ve become irresponsible and irrational.”
Interestingly, a similar debate arose earlier this year when Zaltrap, a new cancer drug, was recently approved by the FDA. Zaltrap is much more expensive than the other medications used. Memorial Sloan?Kettering Cancer Center decided not to carry the drug because of its cost and its effectiveness as compared to other existing, less expensive medications. MSK went on record with an editorial in The New York Times to explain its position.
These questions are never going to go away. But that doesn’t mean the answers are easy to come by, either.