[BLOG]: Hepatitis C market competition arrives for 2015

January 6, 2015

There is plenty of activity already in the hepatitis C market as competition has arrived for 2015, including CVS Health versus Express Scripts and Gilead Sciences versus AbbVie, over FDA-approved hepatitis C treatments. This will have implications for retail prescriptions as well as continuity-of-care programs within non-Medicare accountable care organizations (ACOs) and health systems.

Dr Vogenberg
 

There is plenty of activity already in the hepatitis C market as competition has arrived for 2015, including CVS Health versus Express Scripts and Gilead Sciences versus AbbVie, over FDA-approved hepatitis C treatments. This will have implications for retail prescriptions as well as continuity-of-care programs within non-Medicare accountable care organizations (ACOs) and health systems.

Express scripts may switch hepatitis C drugs on preferred formulary

The market leaders in the pharmacy benefit manager (PBM) and pharmaceutical markets have staked their positions and are ready to battle in 2015, even as other firms are poised to enter the hepatitis C market later.

Gilead’s Sovaldi (sofosbuvir) and Harvoni (ledipasvir/sofosbuvir) will get exclusive coverage on several plans from CVS, taking the opposite stance from competitor Express Scripts.

  • Last month, Gilead learned that Express Scripts would exclusively offer competitor AbbVie’s newly approved hepatitis C therapy Viekira Pak (ombitasvir/paritaprevir/ritonavir;dasabuvir) on its largest plan. 

  • AbbVie’s hepatitis C combination drug will cost about 12% less than its rival from Gilead, fanning the flames for fierce competition for patients of the liver virus.

Where does this leave Merck? That company is not only locked out by the 2 largest PBMs but also recently reported that its attempt to compete with Gilead in finding a cure for hepatitis C has fallen short.

Class action suit latest problem with Sovaldi

Hepatitis C, like many other complex diseases, requires some finesse in treatment. Hence, the current dilemma brought about by these preferred product deals. Because it is not a simple brand drug switch to a similar generic, this is just the beginning of conundrums that will be facing the PBMs and further roiling patients and providers who increasingly hold the real financial risk.

In active research, Access Market Intelligence is developing its study on the specialty pharmaceutical market. Competition in the hepatitis C market is another example that illustrates the way PBMs today can put patients in a bind under the guise of saving money that nobody ever really sees. This also exposes a key limitation in the value of a stand-alone PBM going forward and unintended consequences of silo cost management in an integrated market.

As a result, some key questions remain among market players:

  • How will the increased competition in the hepatitis C market affect the private insurers and government agencies that pay the upfront costs or ACOs that incur costs for the treatments?

  • It is worth noting once more that the curing of over 94% of hepatitis C patients will result in enormous long-term savings to the overall healthcare system, but will these savings ever be realized by private/commercial insurers, ACOs, or self-funded plans?

  • Will this be true competition or just middleman intramural games as usual that probably do little for employers, providers, or patients regarding shared risk arrangements and total cost of care?

Dr Vogenberg is a partner at Access Market Intelligence, and principal, Institute for Integrated Healthcare, Greenville, S.C.