Hepatitis C Drug Dominos Continue to Fall as More Agreements Reached

CVS and Prime Therapeutics agreements follow Express Scripts in hepatitis C formulary updates.

Following the landmark agreement last month between Express Scripts and AbbVie for access to the drug company’s breakthrough hepatitis C treatment Viekira Pak, more companies are updating their formularies after reaching agreements with manufacturers.

Last week, Gilead Sciences Inc announced an exclusive rights deal with CVS Health Corp for the hepatitis C virus (HCV) drugs Sovaldi and Harvoni. The drugs will be offered exclusively through CVS standard commercial plans, Medicare Part D, Medicaid, and health exchange marketplaces.

CVS officials said the drugs provide the best option for treating HCV patients.

“Our goal was to create the lowest net-cost solution for the entire population of patients with all genotypes of hepatitis C,” CVS spokeswoman Christine Cramer told MarketWatch. “When making this decision, we evaluated a wide variety of factors including duration of therapy, relative distribution of genotype and cost of the individual agents in the category as well as the results of a comprehensive clinical review of the different hepatitis C regimens.”

Controversy has swirled around Sovaldi since its launch due to the $84,000 cost for a 12-week treatment regimen. Harvoni costs $1125 per pill, but some patients are able to complete the regimen in just 8 weeks for a price tag of roughly $63,000. Viekira Pak carries a list price of $83,320 for a 12-week treatment cycle.

An analysis released last month by CVS showed an increase in the number of eligible HCV patients receiving treatment after the October launch of Harvoni, which was approximately 2.5 times the rate of Sovaldi prescribing following its launch in December 2013. The report found minimal reduction in Sovaldi use following the launch of Harvoni, which indicates an expanding pool of patients being treated instead of Harvoni replacing Sovaldi, according to CVS.

“The high price of these new hepatitis C treatments and the expanding pool of patients receiving treatment signal a growing and costly trend in treating chronic medical conditions with specialty medicines,” report co-author Troyen A. Brennan, MD, said in a press release. “Hepatitis C is just the beginning, and we need to prepare now for the time when large numbers of patients could be treated effectively with high-cost medicines for a variety of common and more complex conditions.”

In the wake of the agreements with Express Scripts and CVS, pharmacy benefit manager Prime Therapeutics LLC announced new agreements with both Gilead and AbbVie, which place both Harvoni and Viekira Pak on Prime’s preferred drug list.

“There has been a substantial reduction in the net price of both of these drugs just in the past few weeks, so sometimes it pays not to go first,” Peter Wickersham, senior vice president of Integrated Care and Specialty at Prime said in a press release. “It was clear that neither Gilead nor AbbVie wanted to be left off our formulary and the result proved to be significantly better than taking an exclusive position.”

Prime reached the agreement on behalf of 25 million members under its 23 health plans.

“Prime carefully evaluated all options, including an opportunity for an exclusive agreement with each company,” David Lassen, PharmD, chief clinical officer at Prime said in a press release. “However, placing both Harvoni and Viekira on our formulary proved to be the lowest cost option for our clients and, importantly, prevents member disruption. We're pleased with the agreements we have signed with both companies and feel we're positioned well for the future in Hepatitis C treatment.”

Prime is projecting that utilization and costs will peak during the first quarter of 2015 before declining, which is expected to result in a flat cost trend for the HCV class in 2015 compared with 2014.

“First and foremost, our goal is to help people get the medicines that are most appropriate for their condition,” Dr. Lassen said. “We also want to make these medicines more affordable for our members, their health plans and employers. These agreements with both manufacturers will allow more of our members to receive appropriate Hepatitis C treatment at the lowest net ingredient cost.”