Florida's Medicaid program is under assault from the cost of a new hepatitis C drug, called Sovaldi. It costs $1,000 a pill. For one course of treatment, that's over $80,000.
A committee of private doctors and pharmacists that decides whether new drugs should be covered under Florida Medicaid has added Sovaldi to the list. The damage from hepatitis C is too great to deny it to patients, they said.Medicaid HMOs – which are on a budget - are nervous about it, says Audrey Brown, CEO of the Florida Association of Health Plans.
“Right now rates are already set for these managed care plans that are part of the Medicaid managed care expansion program, and this was not a consideration when those rates were being established, so of course the plans are concerned about this cost over and above what they’re going to be reimbursed for”, Brown said.
Medicaid officials declined to be interviewed, but sent word that their actuaries are busy crunching numbers.
300,000 Floridians are thought to be infected with hepatitis C. If one-third of them took Sovaldi, it would cost private and public payers $8 billion.