The Top 4 Most Expensive Drugs in the US are Hepatitis C Treatments

It’s an issue that’s dominating headlines across the country: the price of prescription drugs. On one side, regulators, lawmakers and patients are calling for price caps and increased competition from generics to make runaway drug prices more affordable. On the other, pharmaceutical companies are citing the cost of R&D and the time it takes to get a drug to market as some of the key drivers of inflation of drug prices.

It’s a hotly-debated issue with no clear answer, but we have much to learn from the drugs whose prices are currently pushing the boundaries of affordable healthcare. Below is a review of the top four most expensive drugs in the US, compiled by GoodRx, as of January of 2017. Prices are based on the total cost of the prescription for the duration of treatment, without factoring in insurance coverage or other discounts.

Curing a Chronic Disease

Interestingly, all four of these treatments are for chronic hepatitis C, a liver disease caused by infection with the hepatitis C virus. According to the Centers for Disease Control and Prevention (CDC), between 2.7 and 3.9 million people in the US have chronic hepatitis C.

In 2016, the global hepatitis C market was worth an estimated $13.5 billion, with Zion Market Research analysts predicting that it will grow to $33.5 billion by 2022. While the transmission of hepatitis C virus continues to grow around the world, increased awareness in the US could encourage at-risk individuals to get tested and seek treatment.

The chronic infection is subdivided into 7 distinct genotypes, of which, genotype 1 is the most common in the US. According to the CDC, 70 percent of hepatic C-positive patients in the US have been identified as having genotype 1.

Hepatitis C has historically been treated using interferon therapy in combination with the anti-viral drug ribavirin. When used together, this regimen inhibits the virus from replicating and prevents a hepatitis C relapse, but the virus remains dormant in the patient’s liver cells.

This new class of hepatitis C therapies – known as direct-acting antivirals – are considered to be revolutionary in the space thanks to their ability to effectively cure the disease in the majority of patients. All of these drugs target the hepatitis C viral proteins NS5A or NS5B, which are thought to be involved in viral replication. These drugs are often combined in order to limit the ability of the virus to develop resistance.

In recognition of World Hepatitis Day, let’s take a look at the modern treatments capable of curing patients with hepatitis C.

4 Most Expensive Drugs of 2017 To-Date

1. Drug: Harvoni

Cost: $87,800

Treatment Duration: 12 to 24 weeks

Manufacturer: Gilead Sciences

2016 US Sales: $4.9 Billion

2016 Market Share: 36 percent

What it does: Harvoni is a combination drug containing both ledipasvir and sofosbuvir which is approved to treat patients with chronic hepatitis C virus infection. This drug’s high price is attributed to the fact that it is effectively a cure for patients with certain hepatitis C genotypes, including genotypes 1, 4, 5 and 6. The drug has been associated with a sustained virologic response (SVR) rate – a measure of the absence of detectible hepatitis C in the blood – of over 90 percent.

When it was approved: 2014

DTC Marketing efforts: Gilead has released two direct-to-consumer (DTC) ads for Harvoni, ‘Let Go’ and ‘I Am Ready.’

2. Drug: Sovaldi

Cost: $73,800

Treatment Duration: 12 to 24 weeks

Manufacturer: Gilead Sciences

2016 US Sales: $1.9 Billion

2016 Market Share: 14 percent

What it does: Like Harvoni, Sovaldi (sofosbuvir) is a treatment for chronic hepatitis C with an over 90 percent SVR rate. It is approved to treat patients with genotype 1, 2, 3 or 4. Sovaldi is also being hailed as a cure for hepatitis C when used in combination with other antiviral medications.

When it was approved: 2013

DTC Marketing efforts: In a disease awareness ad, Gilead aimed to make individuals belonging to the baby boomer generation mindful of their risk of being infected with hepatitis C.

3. Drug: Epclusa

Cost: $73,300

Treatment Duration: 12 weeks

Manufacturer: Gilead Sciences

2016 US Sales: $1.6 Billion

2016 Market Share: 12 percent

What it does: Gilead’s Epclusa treats patients with all hepatitis C genotypes, including 1, 2, 3, 4, 5, or 6. The drug combines velpatasvir and sofosbuvir which show overall cure rates between 97 to 100 percent. Epclusa is also approved to treat patients with liver cirrhosis, a patient population that has been historically hard to treat.

When it was approved: 2016

DTC Marketing efforts: None

4. Drug: Zepatier

Cost: $52,600

Treatment Duration: 12 to 16 weeks

Manufacturer: Merck

2016 US Sales: $555 Million

What it does: Zepatier is Merck’s hepatitis C drug, which is approved for adult patients with chronic hepatitis C virus genotypes 1 or 4. The drug is combination treatment of elbasvir and grazoprevir. Patients with genotype 1 have shown cure rates up to 99 percent when treated with Zepatier, while patients with genotype 4 have shown slightly lower SVR rates at 96 percent.

When it was approved: 2016

2016 Market Share: 4 percent

DTC Marketing efforts: None

Not content to have over 60 percent of the market share, Gilead continues to innovate in the hepatitis C space. Late last year, the company applied for FDA approval for a combination of Epclusa and a new drug, voxilaprevir. This combination of three drugs could provide a new treatment option for patients who have previously been unsuccessfully treated using direct-acting antivirals.

This triple-drug therapy was very recently approved by the FDA and will be marketed by Gilead as Vosevi. While Gilead has yet to release the list price for Vosevi, it’s likely that the drug could end up on next year’s list of the most expensive prescription pharmaceuticals given that its list price has been set at $74,760. Rival drugmakers Janssen and Merck also have new hepatitis C treatments in the pipeline.

What are your predictions for the future of the hepatitis C market? Will drug prices in this space continue to be among the most expensive in the industry? Share your opinions in the comments section below!