More than 3 million people in the U.S. have Hepatitis C, a difficult-to-treat infection that can cause serious liver disease and death. When a drug called Sovaldi was released late last year to treat Hepatitis C, it soon made headlines for its 90 percent success rate - and for its cost: $1,000 a pill. The price tag has some states putting treatment on hold, and insurance companies are reeling. Patty Wight reports on the impact of Sovaldi in Maine, as well as the questions it raises about the cost and benefits of certain drug regimens.
About 20,000 people in Maine have Hepatitis C, and many of them don't even know it because of the slow progression of the disease. Marie - who doesn't want to use her last name - was one of those people. She found out she had Hepatitis C 15 years ago, only because her primary care physician screened for it.
"They put me on treatment right away because at that point I had no liver damage," she says.
Marie spent the next 15 years trying different drug therapies to cure her Hepatitis C. Each treatment lasted about a year and involved various pills, shots, and debilitating side effects. There was joint pain. Headaches. Brain fog. It was an emotional roller coaster, says Marie. Because after each treatment, she would get the crushing news that she still had the disease.
"I mean, every time I hear it's back, you break into tears," she says, "because it's the first thing you think of when you wake up, and the last thing you think of when you go to bed."
So when Sovaldi came on the market, Marie was skeptical. But starting in February, she gave it a go. "That one - it was a cake walk. This drug is amazing," she says.
The treatment was 12 weeks instead of the typical 48. And the side effects were minor - body fatigue and some headaches. Her doctor, Alan Kilby, says Sovaldi is the drug he and his patients have been waiting for.
"With almost over 95 percent cure rates," he says. "It's finally going to be fairly routine, I think, to cure this - and without many side effects."
Kilby loves the promise of Sovaldi, but he has a problem with its price: about $1,000 a pill. At one pill a day for 12 weeks, Sovaldi costs nearly $90,000 per treatment - but the full tab can run double, as it's often combined with other drugs. It's caused an uproar among insurance companies. And some states have put use of the drug on hold while they figure out their finances.
"The growth in prices we're seeing for specialty medicines like Sovaldi is simply unsustainable," says Katherine Pelletreau, the executive director of the Maine Association of Health Plans, which represents health insurance companies in Maine.
Pelletreau says specialty pharmaceuticals comprise 1 percent of all prescriptions but 25 percent of costs. Drugs like Sovaldi, she says, drive up premiums.
"When you have a monopoly, as in this case of a specialty medicine which has no competitors, there's no leverage to negotiate a lower price," she says.
The state of Maine filled 184 Sovaldi prescriptions through its MaineCare program by the beginning of June at a tab of $3.5 million. Dr. Laureen Biczak is Medical Director for Goold Health Systems, which administers pharmacy benefits for MaineCare.
"There is a very real concern about how public and private programs can afford a drug that's this costly for a large a population as needs it," she says.
As a result, Sovaldi is being distributed as cost-effectively as possible. Dr. Kilby says he identifies patients who need it most and are more likely to complete the drug regimen.
"We see them regularly with a set protocol, we have specialty pharmacies that are tracking whether or not the patients are using it," he says.
But both Kilby and Laureen Biczak say the controversy over Sovaldi deserves a look back at the past.
"Despite the public the furor over how much something is worth - it's honestly not that much different than we had before."
That's because the cost of a Sovaldi treatment is actually comparable to previous Hepatitis C treatments, which took longer to administer and had lower success rates. Sovaldi maker Gilead Sciences points this out in a written statement defending its price.
But Biczak says the U.S. health care system has just about reached its threshold for the price it's willing to bear for pharmaceuticals. She says Sovaldi marks a time when states, insurance companies, and providers will need to consider the cost versus benefits of various drug treatments.
"This is a cost that - it's a cure. And we have other drugs that cost more per month that are ongoing drugs forever," she says.
Dr. Kilby thinks Hepatitis C patients are being unfairly scrutinized. It's a group that often faces stigma because the disease can be associated with drug use and promiscuity.
"You know, there are lots of expensive treatments for cancers that haven't gotten much attention, and my patients deserve to be treated," he says.
His patient Marie completed her Sovaldi treatment five weeks ago. Though she'll continue testing for a number of weeks, so far this drug appears to have worked. "This is the reason I feel that I did all of the ones before, is to find a drug like this," she says.
So that others, Marie says, won't have to go through what she did to try to cure their illness.