Healthcare Picks Sides in Hepatitis C Drug Battle

Just days after regulators had approved AbbVie’s Viekira Pak and provided real competition for Gilead Science’s expensive hepatitis C treatments, Express Scripts announced an exclusivity agreement with AbbVie in exchange for a lower price.

Others followed suit. CVS Health backed Gilead almost immediately, with Anthem right behind. Humana also opted to exclusively offer Gilead’s hepatitis C drugs, Sovaldi and Harvoni. Now, Aetna has weighed in on the debate, too. On Friday, the third-largest health insurer in the US announced it had negotiated a discount with Gilead after a clinical review of approved hepatitis C therapies, including Viekira Pak.

Gilead’s Harvoni costs $94,500 for a 12-week course of treatment; however, most patients will be able to take the 8-week course for $63,600. Viekira Pak’s 12-week course costs $83,319. While the presence of a competitor can benefit patients as insurers negotiate lower prices, some are concerned that these exclusivity deals can be harmful because: 1) treatment decisions are being taken out of clinicians’ hands, and 2) they set the precedent of prescribing based solely on cost and not overall outcome considerations.

AdverseEvents, a California-based healthcare informatics company that analyzes drug side effect data, recently released a safety analysis comparing Viekira Pak with Harvoni and Solvadi. According to the results, AbbVie’s drug may have a poorer safety profile, which raises the question of whether Express Scripts’ exclusivity deal was based more on clinical data or the opportunity to lower costs.

While both Viekira Pak and Harvoni list fatigue, headache, nausea, diarrhea, insomnia, and bilirubin elevations as adverse events, Viekira Pak has a long list of adverse events that are absent from Harvoni’s label, including anemia, jaundice, liver inflammation, loss of therapeutic effect, and ulcer. The only additional adverse event listed on Harvoni’s label that is not on Viekira Pak’s is lipase elevations.

So far Express Scripts is the only company to make an exclusivity agreement with AbbVie’s drug. Meanwhile, Prime Therapeutics LLC chose not to pick a side. Instead the pharmacy benefits manager made agreements with both Gilead and AbbVie and will place both Harvoni and Viekira Pak on the preferred drug list, reported Specialty Pharmacy Times.

“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 statement. “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.”