I have written before about the high cost ($84K for a course of treatment) of Sovaldi, the new game-changing hepatitis C medication.Why is it OK for Gilead Sciences to make massive profits by selling something that is needed to save the lives of sick people, many of whom are certain to suffer and eventually die without treatment? Apologists for capitalist medicine have defended the high price of Sovaldi, saying things like “Insurance will cover it because it is cheaper to treat and cure hep C than it is treat end-stage liver disease,” or arguing that the magic of the marketplace will eventually drive down the price.
We have already seen that the marketplace is not magic when it comes to drug prices but is monopolistic. Gilead’s competitors are working to make an even more effective hep C treatment (which is a good thing) but have no intention of getting into a price war with Gilead–they are eying the $10 billion Gilead is in line to rake in this year and want to get a piece of that market.
Meanwhile, the argument that “insurance will cover it” is only partially true. This article describes how several states are limiting Medicaid patients’ access to Sovaldi:
States typically have to cover drugs from makers that participate in Medicaid’s drug rebate program, which includes Gilead Sciences, the company that sells Sovaldi. According to the company, 47 states are covering the drug for their Medicaid populations. But in order to limit its use, about half are enforcing “prior authorization,” essentially creating lists of criteria that patients must meet before a doctor can prescribe the drug. Most commonly those criteria require a patient to be in the worst stage of hepatitis C, which is cirrhosis, and that they be drug-free for a period of time. The goal is to restrict Sovaldi to people who already have severe liver damage, which opponents argue is too late. Among the states limiting Sovaldi are California, Florida, Louisiana and Oregon, which typically have larger Medicaid populations and more patients with hepatitis C.
Prior authorization is legal if a state is trying to ensure that a drug is medically necessary and there are other equally effective alternatives that cost less. The question, then, becomes whether there really is an equally effective alternative, said Sara Rosenbaum, a health law expert at George Washington University. (Governing.com)
This is the second stage of the intra-capitalist wrangling that Sovaldi has unleashed. Already, the private insurance companies are up in arms about this costly yet life-saving medication. They think “something ought to be done” about out of control pharmaceutical companies price-gouging. Gilead comes back with the the incontrovertible truth that under capitalism no one has the authority to tell them what to charge, and clearly the market can bear it.
Patients want the best and most effective treatment. States don’t want to bankrupt their Medicaid systems, so they limit access. Why can’t we have both: affordable and effective medications available to all who need them? It’s virtually impossible within the capitalist framework. Instead we have what are in effect “death panels” deciding who gets treatment and who must wait–all so that Gilead can make a profit.
I do wonder if prejudice against people with hep C is playing a role in this as well. It is known that many cases of hep C were transmitted through intravenous drug use. I have observed first hand medical professionals treating hep C patients with disrespect, as if the life of a drug addict (in or out of recovery) is less valuable. I can only compare it to the disregard that has been shown to people with AIDS, especially in the early days of the epidemic, in which the bigoted narrative framed the illness as something that patients had “brought on themselves” with their own behavior, whether that behavior was gay sex or injection drug use.
But, even if we disregard societal attitudes towards drug addiction, (and such attitudes are themselves a product of capitalism’s divisive emphasis on individualism over compassion) the fact remains that the capitalist system allows a life-saving medication to be rationed by pricing it out of the reach of many of those that need it.
A struggle is going to ensue over access to Sovaldi and the other hep C meds that are coming down the pike. Lawsuits will be filed. But it’s going to take more than lawsuits. I’m old enough to remember ACT UP and the AIDS struggle of the 1980s. If we want to win this struggle before more people die avoidable deaths or are forced to experience a serious decline in health before being allowed to take a medication that can eradicate the virus–we have to be in the streets and in the courts, demanding treatment now for all who need it!
