The cost of the groundbreaking Hepatitis C drug Sovaldi, which currently costs $84,000 per course of patient treatment in the U.S., continues to stir controversy. Innovative financing is needed to support the cost of innovative technology, and that’s a lot easier said than done, but much needed if Innovation Districts such as Boston’s are to be able to continue their good work.
With the advent of the Affordable Health Care Act (ACA), the federal Medicaid program and private insurers are put into the politically awkward position of pushing back on the costs of this drug. In a recent editorial, The Wall Street Journal warned that the success and cost of Sovaldi portends that governmentally imposed price controls are just around the corner. If that’s a credible threat, it seems that no good deed goes unpunished.
Sovaldi, a biopharmaceutical drug developed by Gilead Sciences, reportedly has a near 100 percent cure rate. Hepatitis C infects one out of 100 Americans, which makes the patient market very robust, a cruel oxymoron considering the patients’ actual conditions. According to the Centers for Disease Control and Prevention, about 15,000 people die each year from the disease. Chronic Hepatitis C is the leading cost of cirrhosis and liver cancer and the most common reason for liver transplants in the country.
Biopharma’s allure for investors 30 years ago was that the value of treatments it developed would prevent many downstream health costs. We seem to have forgotten that initial concept. Maybe it’s because, since those early days, we’ve seen the failure rate for once-promising drug candidates, and also because our health care system is bearing multiple stressors. Take dementia care. There’s no miracle cure for dementia in sight right now, but if there were, would it get the same kind of pushback we’re seeing with Sovaldi, because of the sheer number of patients who could benefit?
Would that the life of patent protection were as long as some of the afflicted. Patent protection now extends for about 10 years before a drug goes generic.
Insurers cover future costs through investments, and investments in recent years have been anything but certain. When treatment cost models exceed established parameters in a market that isn’t productive enough to absorb them, the irresistible force meets the immovable object.
That’s why drug companies and insurers may need to collaborate on payment models that split some of the drug risk. And the reality of today’s private-pay medical system is that the insurers today may not realize the benefits of their innovations if many of their patients move to Medicare before realizing the benefits the insurers are currently underwriting.
These dynamics have significant impact on the local economy, considering that the life sciences have become a huge job magnet in Greater Boston. The Hub is also a fulcrum of the financial services industry. Our Innovation District community could seize on the opportunity to collaborate on the development of fiscally responsible financing instruments. If there’s anywhere in the country that can get together to provide solutions to this problem, we’re it.n





