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Health insurer Anthem has reached a deal that makes Gilead Sciences’ Harvoni the primary treatment for patients with hepatitis C, following close on the heels of hep C drug announcements by CVS Health and Express Scripts.
Additionally, Prime Therapeutics finalized deals with both Gilead and AbbVie to co-prefer both Harvoni and Viekira Pak to treat hepatitis C genotype 1. Prime said that it “carefully evaluated all options,” and determined that both Harvoni and Viekira proved to be the lowest cost option for its clients.
These moves follow close on the heels of Express Scripts’ decision to make AbbVie’s Viekira Pak the exclusive hepatitis C treatment in its formulary, as well as CVS Health’s announcement that Gilead’s Harvoni and Sovaldi will be the exclusive option for patients on its commercial drug list, as well as those on Medicare Part D and Medicaid.
“Gilead's CVS/Caremark agreement is broader than Express Script's agreement with Express Scripts, offering the standard commercial, Medicare Part D, and Managed Medicaid formularies,” says F. Randy Vogenberg, is a partner at Access Market Intelligence, and principal, Institute for Integrated Healthcare, Greenville, S.C.
More than 3 million people in the United States are believed to be infected with hepatitis C.
“Even though Insurers are beginning to take sides, they are not always aligning with their PBM if they can cut a better deal on their own terms,” says John Santilli of Access Market Intelligence, which provides market intelligence to the pharmaceutical and healthcare industries.
“Anthem represents more than 10% of Express Scripts' patients but was able to negotiate favorable pricing from Gilead on its own,” Santilli explains.
Gilead has been scrutinized for the high cost of Harvoni ($94,500 for 12 weeks of treatment, or $1,125 per daily tablet) and Sovaldi ($1,000 per pill).