Groundbreaking Agreement Makes Hep-C Cure Affordable to Those With HIV

The National Alliance of State and Territorial AIDS Directors has announced a groundbreaking agreement to make a hepatitis C cure more financially accessible to those with HIV.

The NASTAD reports that the AIDS Drug Assistance Program Crisis Task Force has reached a new pricing agreement with the biopharmaceutical company AbbVie for Viekira Pak to treat chronic hepatitis C in those living with HIV.

Viekira Pak (which co-packages ombitasvir, paritaprevir, and ritonavir tablets with dasabuvir tablets) is the only FDA-approved regimen that contains three mechanisms of action (an inhibitor, a protease inhibitor, and a non-nucleoside polymerase inhibitor). These antiviral agents work together to attack the virus at three separate stages of the disease’s lifecycle and acheive a practical cure after 12 weeks of treatment.

Hepatitis C is a liver disease that can become a lifelong chronic illness and is of particular concern for HIV positive people. According to the CDC, “About one quarter of HIV-infected persons in the United States are also infected with Hepatitis C virus (HCV). HCV is a bloodborne virus transmitted through direct contact with the blood of an infected person. Thus, coinfection with HIV and HCV is common…HCV infection progresses more rapidly to liver damage in HIV-infected persons. HCV infection may also impact the course and management of HIV infection.”

AbbVie is the first drug manufacturer to offer a discount on the AIDS Drug Assistance Program (ADAP) price of a medication to treat the hepatitis C virus, which is especially important when it comes to new curative HCV treatments. The negotiated agreement between ADAP and AbbVie reflects voluntary discounts and rebates that significantly lower the price of Viekira Pak compared to normal wholesale pricing.

Even with these discounts and rebates, many AIDS drug assistant programs may remain unable to add Viekira Pak to their formularies because of its high cost. Still, this agreement is important because it recognizes that access to hepatitis C medications is an issue for people living with HIV. Furthermore, it demonstrates to other pharmaceutical companies that lowering their prices can increase the likelihood of their medication being included on the statewide ADAP lists of approved medications.

ADAP make their own decisions about which new medications to add to their formularies, but since 2003, the ADAP Task Force has collaborated with pharmaceutical companies to provide ADAPs access to discounted pricing on HIV drugs.

Hailing the negotiated pricing, NASTAD, notes, “Hepatitis is the leading cause of non-AIDS-related death in people co-infected with HIV and hepatitis. Co-infection of HIV and HCV increases the progression of liver disease and can occur without symptoms.”

These drug assistance programs, which gain funding via the Ryan White Program, can only provide services and medications for individuals who are living with HIV, not those who merely have Hep C. What makes Viekira Pak unique is that it was approved with a co-infection indication—in other words, it can be prescribed to those with HIV and HCV, and HIV funding can be used pay for the medication. 

There is no vaccine for Hep C, but a new class of HCV medications are being hailed as a cure. Viekira Pak’s own FDA approval was based on the results of clinical trials which showed that Viekira Pak cured 92 percent of patients coinfected with HIV and HCV.

Still these currative regimes are often quite expensive and must be taken for 12 weeks to achieve these results. Gilead's Sovaldi has come under attack for its extremely high pricing, reportedly around $84,000 for a 12 week treatment; without this ADAP agreement, Viekira Pak is around $83,000. Which makes AbbVie voluntarily negotiated price cut such an important step.

“This landmark decision by AbbVie to negotiate with the Task Force on an ADAP price for Viekira Pak is an important opportunity to expand access to treatment for people living with HIV and hepatitis C,” stated Annette Rockwell, coordinator of the Massachusetts HIV/AIDS Drug Assistance Program.

Another member of the ADAP Crisis Task Force, Dawn Fukuda, Director of the Office of HIV/AIDS, Massachusetts Department of Public Health, added, “Our long working relationship with AbbVie made this new agreement possible, and means that individuals with HIV and HCV have an opportunity to access curative treatment for HCV and enhance their ability to effectively manage HIV infection.”

The ADAP Crisis Task Force formed in 2002 to negotiate reduced drug prices for all AIDS Drug Assistance Programs (ADAPs). ADAPs provide life-saving HIV treatments to low income, uninsured, and underinsured individuals living with HIV/AIDS in all 50 states and the territories. Current agreements with pharmaceutical manufacturers reduce the cost of antiretrovirals an average of more than fifty percent and have saved ADAPs’ $263 million in 2013 alone. The cumulative savings of these agreements over the decabe between 2003 to 2013 totals more than $2 billion.