WASHINGTON -- It is a potentially deadly disease that now kills more Americans than AIDS.
The good news is there's now a cure for Hepatitis C. The bad news is it literally comes at a very high price.
"I have concerns about the cost of the regimen," says Dr. Richard Elion, director of clinical research at Whitman-Walker Health in D.C.
He says those concerns have been eased because Sovaldi has a high cure rate, and his patients are doing very well.
There have been other high-priced medications in the past, but the market for those drugs was relatively small. In contrast, more than three million Americans have chronic Hepatitis c -- which can destroy the liver -- and the demand for Sovaldi is huge.
"This Hep C drug represents crossing a frontier," says Arthur Caplan, head of the division of medical ethics at the NYU/Langone Medical Center. "You are looking at numbers that are staggering to provide this medicine -- probably 300, 400 billion dollars in the U.S., [and] trillions of dollars to make it available worldwide."
Sovaldi makers are well aware that the health system is already spending a lot of money on treatments for Hepatitis C that are not nearly as effective, Caplan says. "But I think it is fair to say they are charging what they can because they can get away with it."
Dr. John Marshall, a leading cancer researcher with the Lombardi Comprehensive Cancer Center, agrees that pharmaceutical companies are designed to make a profit. He also notes "they are just playing by the rules that we have provided them."
Marshall, also the Chief of Hemotology/Oncology at Medstar Georgetown University Hospital, says these companies are now footing most of the bill for research, and adds the long complicated approval process for new medications costs lots of time and money.
"We want our drug companies to cure us of our diseases," Marshall says. "They are our major investor right now in the process. Not the NIH. Not the federal government."
Marshall wants a complete re-examination of the way drugs are priced in the United States, including more public support for research and development, and a willingness on the part of the nation's leaders to play a little hardball and negotiate prices with the pharmaceutical industry.
The debate over Sovaldi may just be the opening needed to bring about that kind of change, Caplan says: "I have never seen the kind of interest in prices and why they are so high that has accompanied the appearance of this Hep C drug."
That's because many of the people who could benefit from Sovaldi are veterans, or on medicare or medicaid; money for their care comes directly from tax dollars.
The Hepatitis virus is usually spread by blood-to-blood contact, often when users of illegal drugs share needles.
Since the virus can be dormant in the body for decades, it is not surprising that so many patients with Hepatitis C are baby boomers.
"The government is looking at a huge chunk of this tab," says Caplan, adding "most of the cost is going to be put on public programs."
He expects to see a lot of finger-pointing over how people with Hepatitis C got the disease and whether or not the public should pay for their care with tax revenue.
But Caplan believes emphatically that if there's a rock solid cure, there's an obligation to use it.
"You have got to give people cures," he says, "the question is what are you going to do about the price."
The cost of medication is clearly out of control, Caplan concludes: "We are going to see, because of this Hep C drug, a kind of re-examination of the whole way we are paying for the drugs and medical benefits that we all want."
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