As Part of a Comprehensive, Bipartisan Report on the High Cost of Hep C Drugs, Senior Finance Members Collected Data on Drug Costs, Prescription Volume, and Patients Treated in All 50 States, D.C.
State Medicaid Programs Imposed Access Restrictions Due to Budget Constraints, Yet Sovaldi Still Dominated Drug Spending
WASHINGTON - An investigation released earlier this month by Senate Finance Committee Ranking Member Ron Wyden, D-Ore., and Senator Chuck Grassley, R-Iowa, a senior member of the committee, demonstrated the significant financial impact that Gilead Sciences Inc.'s hepatitis C drug Sovaldi and its follow-on drug Harvoni had on state Medicaid programs during 2014, their first year on the market. As a part of the investigation, the senators assembled a comprehensive Medicaid data set based on state-reported data, which is highlighted in detail below. The senators also released today new data on the top 25 state-reported Medicaid drug expenditures, found in the table below.
The 18-month investigation found that because of Sovaldi's high price and Gilead's initial refusal to provide substantial discounts, Medicaid programs were only able treat 2.4% of some 700,000 enrollees infected with the disease, despite spending more than $1 billion on the drug during calendar year 2014, according to state-reported data.
Data provided by state Medicaid programs from all 50 states and the District of Columbia show that Sovaldi ranked among the top five pharmaceutical spending items for 33 different state Medicaid programs. Fourteen states reported that Sovaldi was the top pharmaceutical cost for their fee-for-service (FFS), managed care (MCO), or combined programs. Fifteen more reported Sovaldi was the second highest cost. Four more states reported that Sovaldi ranked third, fourth or fifth in their pharmaceutical spending in 2014. (page 84 of report)
The data provides a state-by-state breakdown of how much state Medicaid programs reported spending on Sovaldi and Harvoni, and where spending on the drugs ranked in comparison to spending on other medications. It also shows the reported prescription count and number of patients treated.
Appendix A of the report aggregated individual states' reported data on spending, prescription and patient recipients, as well as landmark state-reported estimates of Medicaid enrollees infected with Hepatitis C and whether states agreed to supplemental discounts with Gilead for Sovaldi. Appendix A is available in interactive spreadsheet form here. Details on how that data was collected and organized can be found here.
In addition, the senators highlighted letters from 10 states detailing how Sovaldi's high price affected their budgets, providing additional details in several instances, and explaining how their requests that Gilead offer more significant discounts were unsuccessful. Letters included in today's release are from Arizona, California, Florida, Iowa, Kentucky, Ohio, Oregon, Pennsylvania, Texas and Washington.
Gilead's own documents show that nine months after Sovaldi's release, the company analyzed the impact Sovaldi was having on Medicaid programs, concluding that half of state Medicaid programs were "limiting coverage to the sickest patients" and that budget concerns were leading to "strict management" of the drugs availability to enrolled patients. (page 99)
Staff also visualized Medicaid data in a nationwide map, found below. The map examines the percentage of state-reported Medicaid patients with hepatitis C receiving Sovaldi, as well as Sovaldi's rank for each state's Medicaid prescription drug spending.
