Eyeing a $168-million annual price tag for two costly new hepatitis C drugs, state officials hope to limit access to a small fraction of the 20,000 Oregon Health Plan members afflicted by the liver disease.
The new drugs, Sovaldi and Olyssio, offer a cure that lacks the side effects of current treatment. But at $1,000 a pill, the cost adds up quickly – to $84,000 for a three-month treatment.
Other states by law must cover the drugs for their Medicaid programs. And private insurers are under pressure from Medicare to do the same.
But Oregon’s state and federally funded program has a special waiver. It lets the state deny routine coverage of drugs for OHP members based on cost and efficacy.
And that’s precisely what officials plan to do, according to a staff recommendation to be presented to an Oregon Health Authority subcommittee Thursday.