State Spending on Hepatitis C Drugs Could Reach Astronomical Heights

Treating hepatitis C patients who receive health care through Medicaid with Sovaldi could exceed $55 billion.

The high cost of a breakthrough hepatitis C virus (HCV) therapy is going to hit states hard financially if widespread access is provided.

A new report by Express Scripts found that more than 750,000 HCV-infected individuals in the United States receive state-funded health care through Medicaid or the prison system. With the cost of the highly effective regimen of sofosbuvir (Sovaldi) and ribavirin that manufacturers are currently offering through public programs, the report estimates that states could spend more than $55.2 billion if they provided the treatment to all infected patients.

Sofosbuvir carries a price tag of approximately $84,000 for a 12-week treatment course with cure rates in excess of 90%. With health care for many HCV patients funded through state programs, each citizen could face an unprecedented cost burden, as the “unsustainable pricing of this medication has essentially become a tax on all Americans,” Express Scripts wrote in the report.

The United States is projected to spend 1800% more on hepatitis C drugs in 2016 than in 2013, according to an Express Scripts drug trend report. In more than two decades of analyzing drug trend data, Express Scripts said there has been no major therapy class to see a spending increase so large.

The spending jump has already had a significant impact in California, which is projected to spend $6.6 billion if it were to treat all 93,000 chronic HCV patients enrolled in Medicaid and in prison. Rounding out the top 5 states in highest total projected spending are Texas, Florida, New York, and Illinois.

The report found the greatest per capita expense in Louisiana, which has an estimated 18,000 state-funded chronic HCV patients. The report states that providing the sofosbuvir regimen to these patients would cost $1.4 billion, which equates to $294 for every resident living in the state.

The rest of the top five states for highest per capita spend were Delaware ($265), Mississippi ($259), Oklahoma ($223), and Texas ($200).

“As a result of paying for the new treatment regimen, state legislatures may need to make financial tradeoffs elsewhere within Medicaid, prisons, or other important public programs,” the report authors wrote.

Meanwhile, for Florida, Georgia, Illinois, and Nevada, the projected Medicaid spending on HCV drugs comprises 9% of each state’s annual Medicaid budget. In comparison with other state spending categories, the high cost of curing hepatitis C comes into focus.

“Compared to what they spent last year educating a public school student, Utah and Arizona are projected to spend 10 times more to provide medication to a state-funded hepatitis C patient,” the report stated. “Thirteen states, led by Georgia and Louisiana, may spend more on hepatitis C medications than they spent last year on transportation.”