Merck Joins the Once-Daily Hep C Party

It was announced this week that the Food and Drug Administration (FDA) has officially approved Merck’s new once-daily regimen to treat Hepatitis C virus (HCV).  Zepatier (elbasvir/grazoprevir) is a fixed-dose combination tablet for both Genotype 1 or 4 infection and will be prescribed for either 12 or 16 weeks (most will be for 12 weeks).

Drug Pricingmerck zepatier

The release of Zepatier adds an interesting twist to the HCV Drug Price Wars.  As Adam Feuerstein pointed out yesterday in his article on The Street, Merck’s decision to list Zepatier at $54,600 (58% of the price of Harvoni) could put pressure on Gilead to lower the price of its blockbuster.  Feuerstein also points out that the list price is a little misleading since payers typically pay a significantly lower price due to discounts and negotiations to add a new drug to the formulary.  What is actually paid for these therapies will still be a mystery for the general public.

What we do know is that adding a second once-daily regimen to directly compete with Harvoni should give pharmacy benefits managers (PBMs) the leverage they need to negotiate even steeper discounts.  The ability to cure a patient of HCV is an amazing innovation that we should be excited about and willing to pay for.  However, budget constraints have caused policymakers to cringe as we have watched the total drug spend climb thanks to the advent of these therapies.  Hopefully, this new competition will lower the price point enough that the economic models fit within the current budget and we can help get treatment to the patients that need them.

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Joey Mattingly, PharmD, MBA is an assistant professor at the University of Maryland School of Pharmacy located in Baltimore, Maryland. Joey has managed retail and long-term care pharmacy operations in Kentucky, Illinois and Indiana. Leading Over The Counter is a blog of Joey's views and opinions on the topics of pharmacy leadership and management and do not represent the University of Maryland, Baltimore. Joey can be followed on Twitter @joeymattingly.

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