“We are in a new era of HCV control and optimism abounds.”

Harvey J. Alter,  2019 Lecture remarks 

Dr. Alter refers to the non-toxic Direct-Acting Antiviral (DAA) medications which have “unprecedented efficacy” cure rates of 95% to 100% (all genotypes) after 8 to 12 weeks of treatment. 

The high cost of medication in the US is reflected in the 3 Billion of dollars Congress authorized to treat over 180,00 veterans recently.   Not all veterans received treatment however.  This is the subject VA OIG 17-05297-85 Report: Review of Hepatitis C Virus Care within the Veterans Health Administration  (March 20, 2019)  (Link).

For the pdf. (44 pages) see  VAOIG-17-05297-85

The value of medication

It’s somewhat like a sellers’ listing prices for real estate or used boat sales.  The true value of something is what buyers are willing and able to pay.  Low-income countries can’t afford to pay US “retail” pricing so testing sellers like Roche, Abbott, Cepheid, Hologic have set much lower global ceiling prices and can negotiate even lower prices with poorer buyers.  This trend is stepping up because WHO’s Global Health Sector Strategy set a goal to eradicate HCV by 2030.  Some believe this is realistic even without a vaccine.

The CHAI Hepatitis C Market Report

By providing “…market transparency for key stakeholders, including governments,
suppliers, and donors…” CHAI hopes supplier pricing for drugs and testing supplies will help low-income countries afford treatment.” The CHAI report gives prices paid by public health programs via Global Access for inclusive testing products.  Currency exchange rates impact final costs. 

inclusive pricing Page 25.

Hepatitis-C-Market-Report_Issue-1_Web (61 pages)

CHAI reports that access to DAAs are now much more affordable in places like Rwanda; they were able to negotiate a 12-week treatment for $60.00 per patient--and without a volume purchase guarantee.  

Different procurement funds are used to get very low prices. p. 33

CHAI indicates that firm political will is needed to obtain very low prices. Price mark-ups in the United States and legal prohibitions show that its political will favors suppliers and and Congress, not citizens.  PACs are just too corrupting.   

For example

The list price for a 4-week supply of pan-genotypic MAVYRET is $13,200.00 (1/2020) and 8 to 16 weeks of treatment are needed.  Medicare Standard Part D beneficiaries pay the most (“$660.00 – 2,847.00 per month, depending on coverage phase”). 

Afflicted Americans live in a high income country and cannot participate in these programs.   Medical tourism treatment opportunities may be possible in some countries.

The Global Fund offers free online courses on their programs (Link).

The way the drug industry does business needs to be reformed.  We all know it. The CHAI Hepatitis C Report provides more evidence.  

Laura (Guest author)