How much does the drug cost in other countries? When the drug first appeared, Gilead hinted it might be cheaper in places like India, China, and Egypt. What about other countries that contain costs better than we do—like Canada, Germany, or the UK? And speaking of the UK, has NICE, the National Institute for Health and Clinical Excellence, passed judgment on the drug and how it should be used? Is there enough clinical evidence for its use?
Will the price of sofosbuvir drop when competitors show up? This is one to watch. As Stephen Hall reported in his New York magazine piece last fall, “what predicts the price of the next cancer drug is the price of the last cancer drug.” Will the same be true of Sovaldi and its competitors?
Are Medicaid directors in the 25 states that have so far not expanded their Medicaid programs rushing to pay for the new drug? Those states say they aren’t expanding because of the cost of insuring more people. If they are paying for the drug, what figures into the decisions to pay for an expensive drug to help a few while leaving thousands of low income residents without access to health insurance?
What’s the cost benefit analysis? NPR’s first story in early December reported health officials were recommending that some 79 million baby boomers born between 1945 and 1965 should get tested for hepatitis C. Did that mean even the millions who are at zero risk for the disease—those who had no blood transfusions or exchanged needles? In his November piece about the drug, New York Times reporter Andrew Pollock wrote, “For patients who can afford them, the temptation to take the new drugs before trouble arises will be powerful.” Reportters need to ask some questions of the CDC and other experts about the costs and benefits of such measures.
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