Imagine learning that your terminal illness could be cured only to be told that you were going to denied access to the medication that could save you. This is precisely the situation facing thousands of people living with the hepatitis C virus (HCV). Gilead, the maker of Sovaldi, a medication that has shown promise in treating HCV, has come under a lot of fire for the high cost of their product. A course of treatment with Sovaldi costs around $84,000 but is estimated to be up 90 percent effective in suppressing HCV, a notoriously hard-to-treat disease. Since HCV affects an estimated 3.2 million Americans, insurers -- both public and private -- are struggling with how to cover treatment costs.
Some insurers have turned to rationing policies, including denying access to people who use illicit drugs or who have alcohol problems. Preliminary findings from researchers at Harvard and Brown analyzing states' Medicaid programs found 30 states have restricted access to Sovaldi for people with alcohol or drug-abuse problems. These restrictions could result in denying thousands of those most in need access to Sovaldi --one third of young and 70-90 percent of older injection drugs users are HCV-infected.
The problem is that these restrictions have no basis in science. Treating HCV also reduces transmission to others and so makes good public health sense. Moreover, there is no evidence to suggest either that people who use drugs won't adhere to the medication regime or that Sovaldi is somehow less effective for people who use drugs, like opioids. Indeed, in clinical trials, the drug was given with methadone to patients in opioid treatment programs, and the FDA has indicated Sovaldi can be given with methadone without having to make any dosing adjustments. Presumably, people taking legal narcotics, like Vicodin, won't be denied. There don't seem to be any other treatments that Medicaid denies to people who use illicit drugs. So why this one?
The high costs of Sovaldi have made rationing its use an apparently desirable strategy for many states, and the stigma surrounding people who use illicit drugs makes them an easy target. These policies are, at best, based on assumptions not supported by the current science and, at worst, straight up discrimination against a marginalized and often despised group. It's hard to imagine that we would withhold insulin from a diabetic who continued to eat sugar, but denying a life-saving medication to a person who uses or used to use illicit drugs doesn't seem to even raise an eyebrow.
Despite years of proclaiming that addiction is a disease, our government has continued to perpetuate a war on drugs that treats addiction as a crime, not a health problem. Given a broader political and historical context that continues to punish certain people for certain kinds of drug use, as a nation, we generally continue to see people who struggle with addiction, especially addiction to particular kinds of drugs, as the object of our mistrust, scorn, and even hatred. A body of research on drug use and stigma has found that no physical or psychiatric condition is more strongly associated with social disapproval and discrimination than drug use, and people who struggle with drug use are less likely to be offered help than are people with a mental illness or physical disability. Stigma against drug users has long had very real, material consequences, including barriers to accessing health care and treatment and discrimination in employment and housing. Now it seems, stigma against people using drugs can even justify denying them a life-saving medical treatment.
So what's a Medicaid program to do in the face of the astronomically high price of Sovaldi? Instead of denying people who use drugs access to the most promising treatment for this deadly disease, Medicaid programs should be pushing back against Gilead. The New York Times recently reported that Gilead could cut the drug's price by 99 percent and still profit from sales of Sovaldi. Gilead recently made Sovaldi available to developing countries, like India, for $900. Rather than instituting discriminatory rationing schemes, Medicaid programs in the U.S. should be targeting their energy at getting similar deals from Gilead and making Sovaldi available to all who might benefit.
Julie Netherland is the New York deputy state director for the Drug Policy Alliance.