Are the costs of super expensive drugs—to cure whatever ails Americans—justifiable? The drug sofosbuvir, used to treat hepatitis C, has emerged as the poster child for this nagging question. Slowly, the press—which has often acted as a cheerleader for new drugs—is taking a more skeptical look at sofosbuvir, and exploring whether the drug justifies the outlay from the public purse, or from the wallets of insurance companies for that matter. The drug costs $1,000 a pill or around $84,000 for a 12-week course of treatment. When it first debuted in late November—under the brand name Sovaldi, sold by Gilead Sciences—early press coverage was typical of announcements for new drugs; that is, it was laudatory, gave short shrift to the evidence for the drug’s efficacy, lots of ink to the potential for profitability and market share as well as the drug maker’s rationale for its high price. As I noted then, “The story of the new hepatitis C drug opens the door for a renewed examination of the high cost of medicines and their contributions to the high cost of medical care in the US.”
In early January, NPR’s Richard Knox reported on Sovalidi’s pricing by going beyond the drug makers’ standard spiel and interviewing outside experts. One researcher at the University of Liverpool estimated that the cost to produce “a course of these treatments would be on the order of $150 to $250 per person” based on the cost of similar antivirals to treat patients with HIV. A doctor at Beth Israel Deaconess Medical Center in Boston questioned whether the price was justified once the company recovered its initial investment—after which, she told Knox, “I don’t want to say [the price is] unfair, but it does start feeling more exploitative.”
Saturday, The Washington Post’s Sandhya Somashekhar advanced the story by interviewing those who pay for the drug and, what do you know, she discovered some pushback. (Kaiser Health News had a similar report on Monday). Somashekhar reported Molina Healthcare, a company that operates Medicaid managed-care plans in 11 states, has told state officials it cannot bear the cost of covering the drug, and is asking states to pay separately for the drug instead of bundling it into a flat fee. It also is deciding whether to cover it at all. Express Scripts, the country’s largest pharmacy benefit manager, is asking doctors in its networks to delay prescribing the drug if patients can safely wait. This is the first time Express Scripts—whose job is to contain the costs of prescription drugs for employers—has asked doctors to avoid a drug because of its costs. State Medicaid directors say taxpayers will have to pick up most of the cost of the drug because many people who have hepatitis C get their healthcare through Medicare, Medicaid, or the prison system—and Medicaid officials aren’t happy about it .
“Advocates say Gilead has taken corporate greed to new levels,” Somashekhar wrote. (While Gilead touted to the Post its “generous assistance program to help low-income people get the drug at a low cost,” giving some people with low incomes help with the bill doesn’t make the bill lower for the rest of the population, and that bill still gets figured into the insurance premiums everyone pays.) Dr. Arthur Kellermann, dean of the US Medical School, reinforced that point in a tweet on Sunday: “If you have a great new drug, and no sense of shame, this is what you can do. Can our nation afford it?”
That’s a question the press needs to continue asking. A week ago, New York Times reporter Elisabeth Rosenthal told us she hopes her series on the high price of American healthcare will spark a very loud conversation that politicians can’t ignore. How can reporters advance this story and contribute to that conversation? When it comes to reporting fully and carefully on sofosbuvir, here are some questions journalists should be asking:
Where does this drug live on the cost (and efficacy) spectrum compared to other drugs that can fight hep C? In other words, put Solvaldi’s $84,000 price tag in context for readers. The Post describes Sovaldi as costing “more than what many cancer treatments cost in a year,” for example, but the only mention of how it compares to the price of existing hep C treatments is from Gilead itself, which told the Post “the price is fair because it is a signifcant improvement from previous treatments and it is not more expensive than the old treatment.” Kaiser reports that “older drugs cost about $25,000 per treatment, while some newer products approved in 2011 have prices closer to Sovaldi, but have more side effects or are more complex to administer.” Clearly, further reporting is needed here.