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Hep C Drugs Cost FL Medicaid $30M So Far

Nov 18, 2014
Originally published on November 19, 2014 10:29 am

Florida Medicaid has spent at least $30.6 million in the past year on costly drug treatments for Hepatitis C, according to records from the Agency for Health Care Administration. 

Most of the spending was for Sovaldi, an antiviral approved by the Food and Drug Administration in December 2013. It was fast-tracked after clinical trials showed it had a high cure rate for patients in advanced stages of liver disease who were infected with the most common strain of the Hepatitis C virus.

According to information provided by AHCA, Florida Medicaid approved $26.4 million in Sovaldi treatment for 333 fee-for-service patients between the time Sovaldi was approved and October 27.

But AHCA also paid $4.2 million to six HMOS and other managed-care plans in May and June, when most traditional Medicaid patients were moved to private plans as part of the Managed Medical Assistance (MMA) reform. These "kick payments" cover necessary medical expenses that could not have been foreseen at the time the contract was signed.

Sixty patients were treated under the kick payments, AHCA spokeswoman Shelisha Coleman said, but some of them may have been included in the 333 who were treated under the old fee-for-service system.

The payments for July and subsequent months are not yet reported, Coleman said.

Sovaldi made news not only as a breakthrough for a disease that can be fatal or require a transplant, but also for its retail price: $1,000 a pill. Most patients require a 12-week course, which costs $84,000, and some need it for 12 or 16 weeks.

However, Sovaldi now is giving ground to Harvoni, which combines the main ingredient of Sovaldi with another anti-hepatitis drug. The FDA approved Harvoni last month.

The manufacturer of both Hepatitis C pills, Gilead Sciences, says Harvoni is better for patients because it can be taken in a single pill each day. Sovaldi pills had to be combined with intravenous infusion of interferon or ribavirin, both of which caused side effects.

Harvoni's retail price for a 12-week course, $94,500, is higher than the cost for Solvadi. But Gilead says the cost of its two blockbusters is comparable since nearly half of patients require less than 12 weeks of treatment.

Seven months ago, an advisory committee of doctors and pharmacists told AHCA it should cover Sovaldi and a related drug, Olysio, for certain patients, those with advanced disease who might otherwise need a liver transplant, and who were infected with the most common strain, genotype 1.

The rules for use are posted on AHCA's web site. The advisory committee has not yet considered Harvoni.

The agency has enough money to cover the payments this fiscal year, Coleman said, because the 2014 budget estimators anticipated and factored in the extra expense for specialty drugs.

And complicating this question of cost is that not everyone pays retail. State Medicaid programs get a discount under federal law, and private managed-care plans usually can negotiate discounts.

--Health News Florida is part of WUSF Public Media. Contact Special Correspondent Carol Gentry at cgentry@wusf.org. For more health news, visit HealthNewsFlorida.org.