[Ip-health] Doni Bloomfield: Gilead Pills Priced at $1, 000 a Day Are Found Cost-Effective

Elizabeth Rajasingh elizabeth.rajasingh at keionline.org
Mon Jul 13 08:01:11 PDT 2015


Gilead Pills Priced at $1,000 a Day Are Found Cost-Effective
by Doni Bloomfield
July 13, 2015

Because the hepatitis C panel includes some of the top researchers in the
field, many of its members have financial ties to the drugmakers. At least
18 of the 32 panelists received more than $1,000 in payments or funding
last year from either Gilead or AbbVie, according to disclosures on the
guideline website and data published last week from the U.S. Centers for
Medicare & Medicaid Services.

http://www.bloomberg.com/news/articles/2015-07-13/gilead-pills-priced-at-1-000-a-day-are-found-cost-effective

Health insurers that have been reluctant to cover hepatitis C drugs with
list prices of $1,000 a daily dose will face more pressure after a report
concluding the medications are “cost-effective” given their benefits.

The report, still in draft form, is by an influential panel of doctors and
medical experts that helps insurers set policies. While insurance companies
already cover the sickest patients for treatments by Gilead Sciences Inc.
and AbbVie Inc., they’ve resisted extending coverage to people who aren’t
yet showing damage from the disease. Even with negotiated discounts, the
pills can cost hundreds of dollars a day and are taken for eight to 12
weeks.

The 32-member panel is a joint effort by the American Association for the
Study of Liver Diseases and the Infectious Diseases Society of America,
which together represent more than 10,000 physicians, health workers and
scientists. Its recommendations, which haven’t previously included
cost-effectiveness language, will give doctors backing to argue that
insurers should make the drugs more widely available.

The answer to whether these drugs are cost-effective is “a resounding yes,”
Benjamin Linas, a member of the group and a doctor at Boston Medical
Center, said by phone. The conclusions will be issued soon, Linas said.

Linas co-wrote a separate paper that found that Gilead’s drug was only
cost-effective for some early-stage patients after being discounted between
40 percent and 60 percent. The panel’s report refers to the cost of the
drugs after discounts, Linas said.
Health insurers and government programs have negotiated discounts of almost
half of Gilead’s list price, on average, the company has said.

Still Not Cheap

The way the panel defines it, being “cost-effective” doesn’t mean that a
drug is cheap or will save a patient money in the long term. It means the
treatment is worth the price because of its health benefits, weighing its
value against its expense and comparable treatments.
“If you look at the catalog price, which is like the sticker price on the
car, no one actually pays that,” Linas said. “The more realistic, actual
cost, the price people are paying -- it’s in the cost-effective zone.”

The report’s cost-effectiveness conclusions aren’t meant to tell doctors
how to treat patients, he said, but rather to help them “when they engage
with payers so they have some sense of what the big-picture environment is.”

Financial Ties

Because the hepatitis C panel includes some of the top researchers in the
field, many of its members have financial ties to the drugmakers. At least
18 of the 32 panelists received more than $1,000 in payments or funding
last year from either Gilead or AbbVie, according to disclosures on the
guideline website and data published last week from the U.S. Centers for
Medicare & Medicaid Services.
Only eight received no funding or other compensation, such as meals. Linas
got about $125 in meals from drugmakers and said he declined payments or
honorariums offered for speeches.

The panel’s current hepatitis C guidelines are cited by the three largest
U.S. health insurers, the U.S. Department of Veterans Affairs and the World
Health Organization. Health insurers use such guidelines to determine best
medical practices and shield themselves from potential litigation, among
other reasons, said Peter Kongstvedt, a health policy professor at George
Mason University.
Looking for Lawsuits

“There’s about 100 million plaintiff lawyers, trial lawyers out there
waiting for these things to drop, and they’ll use them as the basis for
lawsuits,” he said.

Matt Sobczak, a spokesman for IDSA, said the cost-effectiveness section “is
still in development and IDSA does not yet know the outcome.” Gary Davis,
AASLD’s secretary and a member of the panel, said he didn’t know what would
be in the section but believed it would be mostly educational.

Health insurers consider clinical conclusions such as the AASLD-IDSA
guidelines in making decisions about what drugs to pay for, according to
Clare Krusing, a spokeswoman for industry group America’s Health Insurance
Plans. She declined to comment on how the addition of a cost-effectiveness
section might affect insurers before seeing the text of the revision.

Cara Miller, a Gilead spokeswoman, declined to comment, and Adelle Infante,
an AbbVie spokeswoman, didn’t have an immediate comment.
The new guidelines rely on research that so far has focused mostly on
Gilead’s treatments, Linas said. One of the studies that examined AbbVie’s
drugs also found them to be worth the cost, even at the list price.

“The guidelines that are produced that look at the references, and look at
the randomized studies, and come to good clear conclusions based on that --
that’s a major influence on any payer,” Kongstvedt said.

----
Elizabeth Rajasingh
Perls Research and Policy Fellow, Knowledge Ecology International
1621 Connecticut Ave. NW, Suite 500
Washington, DC 20009
elizabeth.rajasingh at keionline.org | 1-202-332-2670



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