Molina Healthcare, a company that operates Medicaid managed-care plans for 11 states, has told state officials it cannot bear the cost of covering the drug. The company, which gets a flat fee from states for each Medicaid recipient, negotiated its 2014 rates before the FDA approved Sovaldi. It is asking states to pay for the drug separately and is deciding whether to cover the drug at all.
“We can’t absorb this kind of a hit,” said chief executive J. Mario Molina.“It would cause us and other health plans to potentially become insolvent.”
Express Scripts, the nation’s largest prescription drug benefit manager, has said it is encouraging some doctors in its networks to delay prescribing Sovaldi for hepatitis C patients who can safely wait. It is the first time the company, which helps employers keep down the prescription drug costs for their employee health plans, has asked doctors to avoid a drug because of the cost.
The company hopes that when rival hepatitis C drugs hit the market, the increased competition will drive down costs.
“We have a public health crisis that’s been identified in hepatitis C. We now have a drug that is wonderful in its promise,” said Karen Ignagni, president of America’s Health Insurance Plans. “But the pricing of this drug for a public health crisis doesn’t match the situation.”
Lena H. Sun contributed to this story.
Article Appeared @http://www.washingtonpost.com/national/health-science/costly-hepatitis-drug-sovaldi-rattles-industry/2014/03/01/86cab0b4-a091-11e3-9ba6-800d1192d08b_story.html