If 2014 was a year of managing member populations who need a blockbuster treatment for hepatitis C, 2015 is turning out to be one of deals for everyone to access that drug.
Just before the new year, a rival to Gilead Sciences breakthrough hepatitis C drug Sovaldi was approved -- a combination therapy called Viekira Pak sold by AbbVie. The nation's largest pharmaceutical benefits manager Express Scripts wasted no time making Viekira Pak the exclusive option for hepatitis C patients with the most common genotype.
A week later, CVS announced a deal with Gilead to make Sovaldi and its all oral version Harvoni the exclusive treatment for hepatitis C patients on its drugs plans, which cover some 60 million Americans in Medicare, Medicaid and private insurance.
Then Express Scripts negotiated a deal with Gilead to make its treatment the exclusive product on the formulary for Anthem Blue Cross and Blue Shield employer-sponsored health plans.
The deals, all of them, are a sign of competition for a high cost speciality drug that also happens to be a cure in a majority of cases. AbbVie is listing Viekira Pak for a bit more than $83,000, but less than the $84,000 list price for Sovaldi -- and PBMs and insurers are paying something less.
Humana, whose Medicare Advantage plans doubtless include many a baby boomer with hepatitis C, just announced a deal with Gilead to use Sovaldi and Harvoni as the preffered treatment,
Meanwhile, a Blue Cross-owned pharmaceutical benefits manager is taking a different tack.
Prime Therapeutics, the Minnesota-based PBM collectively owned by 13 Blue Cross insurers, has forged deals with Gilead and AbbVie to have both Harvoni and Viekira Pak as treatment for hepatitis C patients within its 25 million member base.
"There has been a substantial reduction in the net price of both of these drugs just in the past few weeks, so sometimes it pays not to go first," said Peter Wickersham, Prime's senior vice president of integrated care and specialty. "It was clear that neither Gilead nor AbbVie wanted to be left off our formulary and the result proved to be significantly better than taking an exclusive position."
Wickersham said the company negotiated with the drug companies on behalf of its 23 health plans and clients, together representing about 25 million members.
"Prime carefully evaluated all options, including an opportunity for an exclusive agreement with each company," said David Lassen, the company's chief clinical officer. "However, placing both Harvoni and Viekira on our formulary proved to be the lowest cost option for our clients and, importantly, prevents member disruption. We're pleased with the agreement s we have signed with both companies and feel we're positioned well for the future in Hepatitis C treatment."