The Sovaldi anti-Hepatitis C $1,000-a-pill has shook the Medicaid program thoroughly.
The problem comes down to who is to foot the bill for the drug in the first place. Medicaid health plans are finding it harder and harder to keep up with the costs while remaining within their already constrained budgets.
“This is going to be a monumental problem for Medicaid and our plans,” Jeff Myers, president and chief executive officer of Medicaid Health Plans of America, a health industry trade group, told Forbes in an interview.
Many states too are worried regarding their monthly and yearly budgets too. To compound matters, the very people most in need of Sovaldi can hardly afford it. They as a demographic comprise the very poor.
Sovaldi is said to be a miracle drug that is supposedly a cure for Hepatitis C. And Hepatitis C is a devastating disease that affects more than 3 million in the USA alone. The whole issue has proven quite problematic for Medicaid.
Judging by the looks of it, over 30% of the patients seeking Medicaid services are infected by the Hepatitis C virus and seeking a solution to their ailment.
“Medicaid cannot handle that kind of charge,” Myers said.
The budget virtually bursts at the seams due to the costliness of the pill. It goes up all the way to one billion dollars which is a lot of money.
The mother pharmaceutical company which created Sovaldi is Gilead. A single course of the drug costs approximately $80,000. Medicaid cannot take this burden for long.
Some health outfits are considering employing the costly drug only on the most terminal of emergency cases. Others want to create a separate account for this sort of astronomical treatment.
This miracle drug has hit the Medicaid program in an unexpected way. The situation is similar to when AZT came on the scene as a partial cure for AIDS in the late 80s.
“Eventually, you are going to have to have some kind of ADAP structure,” Myers said. “You have other drugs coming on board. It doesn’t appear that you are going to have a significant price reduction anytime soon.”
The various health programs were in an awry state due to the impact of the new drug. Ultimately, new infrastructure and detailed planning had to be implemented. The Sovaldi $1,000 pill is a challenge for now though.
How the issue is tackled depends on both the politicians and the medical establishment. They need to cooperate with each other if they want to chalk out a plan that will lead them out of this conundrum.