Despite Cost, Medicaid Programs Spending Heavily on Hep C Drug

Expensive and worth it. That's the verdict from Medicaid programs across the US when it comes to the new hepatitis C antivirals. State spending figures are available in a study published as a letter in the New England Journal of Medicine.

The effectiveness of new antivirals for hepatitis C virus is undisputed. But price—as much as $1,000 a pill—has caused concern. That is particularly true for the states’ Medicaid programs.

Nevertheless, new analysis of spending on one such drug's first year of availability in the US shows that Medicaid programs in every state are buying the drug and spending as much as 44.3% of their Medicaid drug spending budgets on it. That was the case for Hawaii, which spent $21 million on sofosbuvir.

Writing in the New England Journal of Medicine Joshua Liao, MD and Michael Fischer, MD, of Brigham and Women’s Hospital in Boston, Mass, offer an analysis of states’ Medicaid programs spending on sofosbuvir (Solvaldi/Gilead).

Their data are for 2014 and come from the Centers for Medicare and Medicaid Services.

The cost of the drug made up 6.73% of Medicaid drug spending in New York, or $354 million, the highest amount in the US. In NY, 36.9% of HCV prescriptions were for sofosbuvir. The state’s rate of acute HCV cases was not unusually high, 0.5% per 100,000 population.

That was far higher than the next highest spending state, California, which spent $93,673.967 on the drug and 34.4% of HCV prescriptions were for sofosbuvir.

Overall state spending ranged from NY’s $354 million to New Mexico’s $593,000. The figures did not account for manufacturer’s rebates and the states may have prescribed other HCV drugs to Medicaid enrollees.

Rates of acute HCV infection were highest in Kentucky at 4.1 cases per 100,000 population, West Virginia at 3 cases, and Oklahoma at 2.1 cases,

The main finding, the authors noted, was that “in the first year after the approval of sofosbuvir by the FDA, there was a rapid, widespread increase in Medicaid spending on sofosbuvir, but with substantial variation across the states.

The results “underscore the need to identify effective strategies to guide policy and reimbursement in order to ensure parity and appropriateness in the use of sofosbuvir among the Medicaid population and other high-need populations.”

That finding applies even more to groups like prisoners and to the uninsured.