Despite High Costs, VA Makes Sure Veterans Have Access to Newest HCV Drugs

By Annette M. Boyle

WASHINGTON – While commercial insurers responded to the approval of the breakthrough drug sofosbuvir for hepatitis C (HCV) by implementing prescribing restrictions, limiting use to the sickest patients and charging higher co-pays because of the drug’s expense, the VA has left use of the drug up to the physician and patient to determine.

Sofosbuvir gained Food and Drug Administration approval in December 2013. The VA began prescribing it in January 2014 and added sofosbuvir to the national formulary in March.

VA guidelines issued in May recommend use of the drug for treatment of HCV genotypes 1, 2 or 3 with or without co-infection with human immunodeficiency virus (HIV). As of September, 5,500 veterans have taken sofosbuvir, according to David Ross, MD, director of the VHA’s HIV/HCV and public health pathogens program.

“VA continues to make use of therapeutic advances for combating the hepatitis C virus to benefit veterans. Our mission is to provide the best quality, safe and effective healthcare veterans have earned and deserve,” Ross told U.S. Medicine.

The VA has one significant advantage over commercial insurers in using sofosbuvir: pricing. The drug costs $1,000 per pill retail, but federal supply schedule pricing means that the VA pays 40% less, $600 per dose, according to Ross.

That’s still quite a lot of money, particularly as sofosbuvir must be taken with ribavirin with or without interferon. It also is sometimes prescribed with another pricy new drug, simeprevirin, for patients who cannot tolerate interferon, though that combination has not yet received FDA approval. The total retail cost for the combination therapy runs $95,000 to $150,000 (if simeprevir is used) for a 12-week course of treatment.

For the VA, though, even that cost represents a real savings. “Although no precise savings projection is available, sofosbuvir-based regimens are expected to substantially increase the number of veterans achieving a cure, which may translate into significant downstream cost offsets to drug treatment,” Ross said. “Specifically, successful treatment of hepatitis C infection is anticipated to result in reductions in liver-related complications, which may otherwise lead to hospitalization, hepatocellular carcinoma or the need for transplant.”

1 2 3

Comments (1)

Trackback URL | Comments RSS Feed

  1. Carlos says:

    I think its great that the VA is using the latest treatment for HCV, our vets absolutely deserve the best. However, this idea that the VA or by extention the US taxpayers are getting a great deal with paying 40% less per pill is not the entirely that great of a deal. Considering that this company is making a branded form of this medication is southeast Asia (likely where a significant number of our vets contracted HCV) and total treatment cost is < 5K and there are plans to make it generic in southeast asia. Oh by the way this includes Vietnam, so they are getting a much better deal on this medication for their general population and vets. Why can't we negotiate a better deal with this company for our veterans and US taxpayers?

    I bring this disparity in cost up, because healthcare cost seems to one of our biggest obstacles. Our healthcare costs continue to grow and our budget does not. This highlights one of our problems.

Share Your Thoughts