By Leslie Small
Beginning this month,
Louisiana has been able to treat hundreds of patients who were waiting to
receive a pricey cure for hepatitis C thanks to after hammering out an
innovative payment model with a drug manufacturer.
But the road to get there
was long and difficult, according to Rebekah Gee, M.D., secretary of the
Louisiana Dept. of Health, who, during a July 22 event hosted by the Brookings
Institution, detailed the challenges she faced in trying to get a costly curative
therapy to more people while facing down a $2 billion budget deficit. "We
were told 'No' at least 50 times from a variety of people, whether it was the
industry, or policymakers or individuals at the CDC…because it had never been
done before," she said.
Here's how the
"modified subscription model" works: The state pays a fixed amount to
Asegua Therapeutics LLC, a subsidiary of Gilead Sciences, Inc., for the
authorized generic of Epclusa (sofosbuvir/velpatasvir tablets), up to a set
spending cap, and in return gets unlimited access to the therapy for Medicaid
beneficiaries.
For states that want to
successfully replicate what Louisiana has done, not only do they need a solid
partnership with CMS, but they must understand that price is not the only
barrier to expanding treatment, said Neeraj Sood, a professor at the University
of Southern California, who helped develop the model.
"Even if you make
the price zero, you have to figure out how to test everyone, link them to care,
make sure they adhere to therapy — and that’s no small task," he said.
From Health Plan Weekly
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