| April 11
April 11 Texas is reconsidering whether to
impose strict limits on Gilead Sciences' $84,000
hepatitis C treatment for patients on the state's Medicaid
health plan for the poor, at the urging of outside advisers, a
state official said on Friday.
The Texas Health and Human Services Commission, which
oversees Medicaid, had proposed a policy to allow the drug,
Sovaldi, to be used mainly for sicker patients, such as those
whose hepatitis C had developed into advanced liver disease,
according to state documents reviewed by Reuters.
As with most state Medicaid programs, an outside committee
of pharmacists and doctors in Texas meets quarterly to review
new drugs and recommend policies to the state's Medicaid
director. The agency had been planning to begin offering
coverage of the drug in July if the committee recommended the
policy at its Thursday meeting.
"The board asked state staff to meet with stakeholders,
including gastroenterologists, about the criteria, whether it
was too strict, and the prior authorization process," Texas
Health and Human Services Commission spokeswoman Stephanie
Goodman said. In the interim, Medicaid patients in Texas will
still not be prescribed the drug.
"We're looking at our options and how that will affect our
timeline to get the drug covered," Goodman said.
The deliberations in Texas, one of the most populous states
and home to a relatively large number of hepatitis C patients,
underline the difficulties of state health officials in deciding
how to cover the Gilead treatment. It was expected to be the
first major state to make a decision; discussions are continuing
in California, Colorado and Virginia among others.
Sovaldi has become the focal point for a global outcry over
the price of novel medicines, attracting criticism from the
World Health Organization, doctors' groups, state officials and
insurance industries. The drug is the first to provide a true
cure to the disease for most patients who take it, but its cost
could reach more than $200 billion if widely used in the United
States, posing huge risks to state budgets and insurers'
The Texas move has also tabled a plan that the state had
hoped could also be in place by July to make supplemental
payments to insurers to help offset the high cost of the drug.
Gilead Sciences received U.S. regulatory approval for the
treatment in December. Many patients are prescribed the drug in
combination with another new drug, Johnson & Johnson's Olysio,
pushing the cost of a 12-week treatment to around $150,000.
Texas is among states including California and Florida which
were asked by insurers who manage Medicaid plans to pay for the
treatments directly, a move they said was needed because they
would otherwise lose money on their contracts.
California is still discussing the issue. Florida said it
has no plans to carve out the drug but continues to monitor the
drug's use within managed care plans.
(Reporting by Caroline Humer; Editing by Michele Gershberg and