Merck and Co. have cleared the FDA hurdle with a new Hep C treatment option, Zepatier at $54K for 12 weeks of treatment. Already on the market are Gilead with Sovaldi and Harvoni, AbbVie with Viekira Pak and Technivie, Bristol-Myers Squibb Co with Daklinza. Sovaldi ($84 K for 12-week treatment) and Harvoni ($94.5K for 12 weeks) are expecting to announce 2015 sales of $18 Billion. AbbVie with Viekira Pak ($83K for three tablets daily for 12 weeks) and Technivie ($76.6K for 12 Weeks) expect sales in the $1.5 B arena.
Merck is introducing Zepatier at $54K for 12-week Hep C treatment. They are hoping to bring the market to them at this introductory price. Still a mystery is what more expensive modalities are passing back to the PBM’s as discounts and rebates. The $54K figure is Merck’s guess at the discounted treatment price.
Does this place Zepatier on a level pricing field? We may never know because manufacturer contracts with the PBM on rebates and discounts are proprietary.
Ok, so this begs a couple of questions. First, who becomes saddled with the final cost minus rebates and discounts of expensive medications? Second, does Merck not have a rebate and discount contract with the PBM for any rebates and discounts to pass on to the paying customer? Answers to these unknowns are essential to maximizing therapeutic outcomes with efficient use of the pharmacy dollar.
There are medical reasons to choose one product over another because of differing Hepatitis C genotypes presented. Now there are price considerations to be made with Merck’s new entry into the market. It is important to point out that all of these new treatment options for Hep C come with coupons further discounting either co-pays or part of the total cost for those under treatment. How coupons affect the end payer’s total outlay for a particular Hep C medication can also be a costly unknown.
Since the health plan with the pharmacy benefit holds the check book for drug costs, not the PBM, how does the health plan’s approach to balancing cost and therapeutic requirements impact the pharmacy benefit dollar? How hard is your PBM working for you to share those manufacturer’s discounts and rebates? APC can help align costs and PBM flexibility for your financial advantage in a complex world of newly introduced expensive curative options.
