AbbVie, Gilead Throw Punches in Hepatitis C Drug Boxing Match

Those of us who remember the drama of the match between the Italian Stallion and Apollo Creed might believe that something similar is going on between AbbVie and Gilead these days.

In round 1 several weeks ago, AbbVie shocked the managed care world in a surprising deal with Express Scripts for preferred status of their newly approved chronic hepatitis C virus (HCV) treatment, Viekira Pak. Providers and pundits protested the injustice of forcing an inferior treatment on patients in a move that was clearly more about money than medicine. It was a sucker punch, but it landed hard.

But Gilead and its once-daily Harvoni treatment struck back in round 2. In a recently announced deal with CVS Health, Gilead managed to muscle its way into the preferred position of the second largest pharmacy benefit manager (PBM) in the country. And while AbbVie was still staggering from that shot, Gilead landed yet another punch just last week in a deal with Anthem for preferred status on its formulary for all Anthem members.

I can almost hear "The Eye of the Tiger" playing in the background. We’ve got a barnburner on our hands, unlike anything we have seen recently.

What’s going on?

What we are watching is a bout for market share between 2 fiercely competitive and committed companies. In one corner, there appears to be a clinically superior option with fewer side effects and more convenient dosing schedule named Harvoni. In the other corner is Viekira Pak, which by all accounts is the underdog in this match, as it was approved by the FDA later and often needs to be taken with ribavirin, an addition that is notorious for side effects.

So, which do you bet on? The answer to that question is not as clear cut as you might think.

In this game of high stakes business boxing, there is another very important factor that comes into play. The real questions are: what kinds of discounts did each company have to offer in order to achieve the coveted preferred position on the respective formularies? And how deep did they have to dig in order to be the top choice for treating HCV for the lives covered under each PBM or plan?

The last round of this fight, however, is still months away. Neither company has disclosed their discount deals, but when earnings are released at the end of the quarter, I’m sure the business-math gurus will have no trouble estimating how much each company had to give up to win the round. Then, and only then, will we know who won the fight.

The fact is, depending on the deals, the weaker and poorer fighter can actually win the match. There is a boxing strategy which dates back to at least the days of Muhammed Ali known as “rope a dope.” In this technique, a boxer actually allows himself to be pummeled against the ropes, utilizing his elasticity to absorb some of the hits, while the aggressor exhausts himself in the process of throwing these punches. This allows the pounded player to bounce back and beat his tired opponent who has used up and wasted most of his strength ineffectively. Ali used this approach against the seemingly stronger George Foreman in the 1974 “rumble in the jungle”, and in doing so, he won the fight.

Who is the “dope” in this fight between AbbVie and Gilead? I don’t know, and neither is ready to throw in the towel. Both Viekira Pak and Harvoni have FDA approval, good data, and market share. It will be interesting to see how this fight turns out.

What I like most as a pharmacist is that either way, in my opinion, the patient wins. We now have a virtual cure for a previously untreatable condition. We need to iron out the access issues, and competition in the market makes that process faster and ultimately more affordable.

The system isn’t perfect, but I’m happy to know that many patients who only had liver cancer or cirrhosis to look forward to now have a brighter future ahead. That’s good enough for me.

So, go ahead and ring the bell. This pharmacist is ready for another round.