The new hepatitis C drug Sovaldi is being hailed as a potential breakthrough treatment for a disease that affects about 3.2 million Americans. It’s also vexing insurers, who worry about the drug’s $1,000-a-day-price tag. (The full 12-week course of treatment runs about $84,000).
One set of insurers is particularly worried about the cost: Medicaid managed care plans covering patients in the low-income health-care program. Medicaid health plans figure anywhere between 20 percent and 30 percent of those infected with the liver-attacking disease are in Medicaid.
The experience of Sovaldi plays into the larger debate about the cost of health care, who ultimately pays and how to deal with available resources. The Medicaid plans aren’t publicly recommending how states should approach the new drug — they say each state’s Medicaid program will ultimately handle this differently. But expect this issue will continue to play out in a big way over the next few months.