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3 of 3 Premium Clicks used this month SUBSCRIBE Print + Online Subscriber Activation | Register x Forgot Password | Need an Account? e-edition | subscribe | newsletter | deals Classifieds Jobs Autos Real Estate FEATURED » NEWS NOW Rogue Community College hosts candlelight vigils for UCC shooting victims ... Mail Tribune Pulitzer among random items almost taken during break-in ... Donors pour $250,000 into relief fund for UCC victims ... Rogue Community College hosts candlelight vigils for UCC shooting victims ... Mail Tribune Pulitzer among random items almost taken during break-in ... Donors pour $250,000 into relief fund for UCC victims ... SUNDAY FOCUS: HIGH-COST MEDICATION Cost of curing hepatitis C? $1,000 per pill New drugs can cure hepatitis C. But at this price, some insurers cover only those gravely ill By Vickie Aldous Mail Tribune MailTribune.com By Vickie Aldous Mail Tribune Posted Oct. 4, 2015 @ 12:01 am By Vickie Aldous Mail Tribune Posted Oct. 4, 2015 @ 12:01 am » Social News p bs:newslist StartDate="20121121" EndDate="p bs:datecalc Months="3"" DateSort="1" UseObjects="1" ObjectClass="81" Taxonomywords="2325,665" ExactTaxonomyMatch="1" Image="1" Count="4" --> Dr. Lyle Jackson remembers his reaction when he heard new drugs that can cure hepatitis C would be priced at about $1,000 per pill. "My word is greed — pure and simple," said the family practice physician. "When one pill costs as much as a mortgage payment, something is wrong. The reason they can do it is they're allowed to do it. It's corporate greed. Shame on them." Breakthrough drugs such as Sovaldi and Harvoni inspired hope among health care providers and patients when clinical trials showed they could eradicate the hepatitis C virus from a vast majority of patients — essentially curing people of a chronic illness that can last for decades and lead to cirrhosis of the liver, liver cancer and death. But excitement turned to anger and dismay when prices were revealed. Sovaldi costs about $84,000 for a 12-week course of treatment — or $1,000 per pill. The price for Harvoni has been widely reported at $94,500 for 12 weeks worth of pills, or $1,125 each. That has led AllCare Health and Jackson Care Connect, which coordinate care for Oregon Health Plan patients in Southern Oregon, to place limits on which patients can get the new drugs. Southern Oregon Rehabilitation Center and Clinics, which serves veterans at its White City facility, is allowing all veterans who want the drugs to receive treatment. But the center has burned through two supplemental pools of money it received this fiscal year to treat patients and has hundreds more who need care. Jackson, who in addition to being a doctor is the chief clinical adviser to AllCare, said the cost of the new hepatitis C drugs has the potential to bankrupt the Oregon Health Plan and drive up the cost of private, employer-provided insurance so high that businesses and workers would no longer be able to afford the premiums. And with the whole baby boomer generation considered a risk group for hepatitis C, the drug costs could have major impacts on Medicare, doctors and pharmacists said. Breakthrough drugs Past drugs for hepatitis C could take six months to a year to work and had side effects that were so serious — and sometimes life-threatening — that many patients dropped out of treatment. Less than half of patients who endured the treatment saw the virus cleared from their bodies, according to health care experts. The new drugs have far fewer side effects, have a shorter treatment time and have cure rates above 90 percent, experts said. But if AllCare spent its whole medication budget for all diseases and conditions just on new hepatitis drugs, it would only be able to treat 10 percent of its hepatitis C patients, said a clinical pharmacist for AllCare. "It makes your stomach knot up. You realize there is simply not enough money," she said. AllCare officials asked that her name not be used because of the strong emotions and threats triggered when patients are told they cannot receive certain drugs. "These medications for hepatitis C are extraordinary," she said. "But the price point they put on it was clearly outrageous. There's no other way to get around this other than to say this is greed. They knew they had an extraordinary medication and it would become the standard of care. We're lucky they didn't price it at $2,000 a day. No one was going to stop them." In 2012, the company Gilead Sciences Inc. bought out the original developer of Sovaldi, Pharmasset Inc., for $11.2 billion, according to the U.S. Senate Committee on Finance. In the first three quarters of 2014, Gilead made $11.4 billion off sales of Sovaldi, recouping its acquisition costs for Pharmasset in less than a year, according to quarterly earnings reports. With 3.2 million Americans infected with hepatitis C — or about 1 percent of the population — Gilead stands to earn untold billions off the drug. Pharmasset Inc. had planned to sell Sovaldi profitably for $36,000 for a course of treatment. The company reported it spent $62.4 million on research and development for the drug, according to the finance committee. Once Gilead had control of Sovaldi, it raised the price to $84,000, according to the committee. Sen. Ron Wyden, D-Ore., chairman of the committee, has asked Gilead to provide detailed documentation regarding its pricing of Sovaldi. An estimated 100,000 Oregonians have hepatitis C, although half don't know they are infected. Gilead has defended its pricing of Sovaldi, pointing out it represents a breakthrough compared to the problematic treatments of the past. The company says the new therapy can help prevent costly spending to treat cirrhosis, liver failure, liver cancer and liver transplants. The average cost of a liver transplant in America was $739,100 in 2014, according to the Milliman Research Report, which provides actuarial data worldwide. Gilead and makers of other high-priced hepatitis C medications have said they offer assistance programs to help low-income people afford the drugs. Gilead is offering its hepatitis C drug for much lower prices in developing countries such as India and Egypt. The national health care systems in countries such as Canada and Germany have also negotiated discounts. It would be cheaper for AllCare to fly its hepatitis C patients to other countries for treatment than to pay for just the drugs in America, but federal regulations bar such practices. AllCare also is banned from buying drugs from other countries. An AllCare staff member could not travel to India and come back with a suitcase full of Sovaldi bottles, for example, AllCare officials said. "You can buy these medications for pennies on the dollar in other countries," said Jackson. "The only country that pays $1,000 per pill is the United States. Because of the current law structure, we're subsidizing the world." Legislation has been introduced in Congress that would allow Americans to buy drugs from Canada, and to allow Medicare to negotiate directly over drug prices. Who gets care? Because it cannot afford to offer the drugs to all its hepatitis C patients, AllCare considers the severity of a patient's liver disease when deciding treatment. Patients in stage four of hepatitis, the last and most severe stage, are eligible for treatment. Patients must meet other criteria as well, such as showing the ability to abstain from alcohol, which damages the liver, officials said. Like AllCare, Jackson Care Connect cannot afford the new medications for all its hepatitis C patients. Jackson Care Connect is also limiting the new drugs to patients in stage four of their hepatitis C infection, officials said. At stage four, the patient already has scarring of the liver and many of the health complications of hepatitis C have emerged, according to the academic medical center California Pacific Medical Center. Jackson Care Connect is one of four coordinated care organizations that make up CareOregon. CareOregon provides coverage for many Oregon Health Plan patients in Southern Oregon, along the coast and in the Portland and McMinnville areas. If CareOregon took the money it spends for all prescription drugs — including birth control and medication for diabetes, cancer and heart disease — and spent that money just on hepatitis C drugs, it would be able to treat only 25 percent of its hepatitis C patients, said James Slater, director of pharmacy for CareOregon. "You can see the quandary we're in," he said. In some cases, coordinated care organizations can obtain a mix of reimbursements and price reductions that can reduce the drugs' costs by about half, Slater said. But even at half off, CareOregon could spend its whole prescription drug budget and only treat half of its hepatitis C patients, he said. Doctors point out that not all hepatitis C patients need treatment. In many cases, the disease progresses slowly over 15 to 30 years, buying time for patients. About one-fifth of infected people will fight off the virus on their own and avoid long-term hepatitis C infection. About one-fifth will suffer liver damage over the years and develop cirrhosis, severe scarring of the liver, according to the U.S. Department of Veteran Affairs. Of the patients with cirrhosis, approximately 15 percent will develop liver cancer, according to the VA. Hepatitis C is spread mainly through contact with infected blood, putting injection drug users, health care workers and those who received blood transfusions before 1992 most at risk. But the disease can also spread through the sharing of razors or toothbrushes, and to babies born to mothers with the disease. Veterans and baby boomers are among the groups with higher rates of infection than the rest of the population. Private insurance coverage of the new drugs varies widely based on factors such as the extent of prescription drug benefits. If cost were not a factor, widespread use of the new drugs could eliminate the virus from the bodies of most patients — thus cutting the spread of the disease and new cases of infection. Influx of patients In February, the VA issued a statement that all veterans with hepatitis C who wanted treatment with the new drugs could receive care, said Dr. Donna Cox, clinical pharmacist for Southern Oregon Rehabilitation Center and Clinics. That led to an unexpected increase in the number of veterans seeking care, she said. The VA had gone to Congress and won additional funding to treat hepatitis C patients, but the money didn't last. "By June, we had used up all those funds. They had been meant to last to the end of September, which is the end of our fiscal year," Cox said. SORCC responded by allowing veterans to seek medical care out in the community from non-VA physicians through its Choice Program, which is used when the VA cannot meet medical needs. The VA then received a second round of supplemental funding to last through the end of September so veterans could again be seen by VA health care providers. That money has also been used up, Cox said. The VA has had difficulty paying for the new hepatitis C drugs even though it has used its national buying power to win discounts from drug makers. SORCC is paying an average of $40,000 per patient for the drugs. It has had to pay $5 million to treat just 125 hepatitis C patients for the fiscal year that ended on Sept. 30, Cox said. In comparison, SORCC spent $9 million on medications for all other conditions and diseases combined, she said. Last fiscal year, the center treated 18 veterans for hepatitis C, officials said. Because of the negative side effects of older drugs, the VA typically treated veterans who were suffering health problems from the disease. "We used to treat the sickest first. Now we are treating veterans earlier in hopes they won't incur damage to the liver," Cox said. She said, ultimately, Congress must do more to control the costs of new drugs. She said the high costs of new hepatitis C drugs are just the tip of the iceberg. Cox said many other new medications also come with high price tags. She pointed to oral cancer drugs that can keep patients in remission, but a patient must continue to take the drug for the rest of his or her life — at a cost of $5,000 to $10,000 every month. Cox said she doesn't know yet whether Congress will authorize supplemental funding that will allow the VA to continue treating hepatitis C patients with the new drugs in the fiscal year that began on Oct. 1. "We have an estimated 650 patients more to treat," she said. Even with a discounted price of $40,000 for a course of hepatitis C treatment, the center will need another $26 million to treat those veterans. "It's mind-boggling," Cox said. Staff reporter Vickie Aldous can be reached at 541-776-4486 or [email protected] . Follow her at www.twitter.com/VickieAldous . By Vickie Aldous Mail Tribune MailTribune.com By Vickie Aldous Mail Tribune Posted Oct. 4, 2015 @ 12:01 am » Comment or view comments Terms of Service /* $( document ).ready(function() { // Jquery mobile is trying to style the button and leaving a blank gry button on top of a white button $("#viafouracoms .vf-comment-controls li.vf-right").html(' Submit '); });*/ » STAY INFORMED Email NewsLetter Sign Up Today Sign up for our newsletter and have the top headlines from your community delivered right to your inbox. calendar Connect with MailTribune.com Facebook Twitter RSS Back to top Reader Services Reader Services Home Subscriptions Subscriber controls Contact us Submissions Photos Events Letters to the editor Corrections Announcements Obituaries Story ideas Since you asked Alerts Email Alerts RSS Feeds Text Alerts Advertise Media Kit Home Products and services Ad rates Advertising contacts Propel Marketing Mail Tribune Daily Tidings The Nickel Shop Our Valley Blogs Mobile Site Stay Informed Email newsletter Sign Up Today Sign up for our newsletter and have the top headlines from your community delivered right to your inbox. 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