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    Hepatitis C pricing heats up with new drug

    Much of the drug pricing debate in the United States in recent months has centered around the soaring prices of Hepatitis C medications such as Harvoni and Sovaldi (Gilead Sciences), along with Technivie and Viekira Pak (AbbVie). However, the newly approved hepatitis C drug, Zepatier (elbasvir and grazoprevir, Merck) ups the pricing competition.

    Merck is pricing Zepatier at around a 35% discount to the list price of the competing drugs, priced as high as $94,500 per treatment regimen.

    Related: Hepatitis C drugs come under fire again

    We believe the discounted list pricing strategy (before rebates) is necessary in this highly competitive segment, given narrower indication and the prior-treatment mandatory liver function testing highlighted in the drug label. Zepatier requires liver function testing prior to, and during treatment,” Citigroup’s Andrew Baum wrote in a research note. “This compares unfavorably to Technivie’s updated labels which recommends hepatic laboratory testing only during the first 4 weeks of treatment, and the unencumbered label of Gilead’s Harvoni. While Merck’s US label for their HCV agent is clearly inferior to incumbent competitors, we expect the launch of Zepatier to further drive net price reductions for the all market participants.”

    Merck has set a list price of $54,600 for a 12-week regimen, which the company believes to be in the range of net prices for other commonly used HCV direct-acting antiviral regimens at 12 weeks of therapy. “Merck anticipates that this price, as well as our comprehensive access strategy to seek broad coverage across commercial and public segments, will help broaden and accelerate patient access to treatment and move us closer to our shared goal of reducing the burden of chronic HCV in the U.S.,” according to a company statement.

    Privately insured patients who have difficulty affording the copay set by their insurance plan may be eligible for significant copay assistance and may pay as little as $5 for each prescription, Merck said. Merck also offers assistance to patients who cannot afford Zepatier through Merck’s Patient Assistance Program, which provides certain drugs free of charge to eligible patients.

    Related: CVS Health commits to Gilead's hepatitis C drugs

    Zepatier was approved with a treatment duration of 12 or 16 weeks, depending on HCV genotype, prior treatment history and, for patients with GT1a infection, the presence of certain baseline NS5A polymorphisms. A 12-week, once-daily regimen is recommended for the vast majority of patients for whom Zepatier is indicated.

    “This approval provides patients and physicians with an additional treatment option that has the potential to cure many patients with chronic hepatitis C in the United States,” said Ira Jacobson, MD, site chair of the Department of Medicine, Mount Sinai Beth Israel, New York. “Zepatier is a once-daily, single-tablet direct-acting antiviral that has demonstrated high cure rates in genotype 1 and in genotype 4, including treatment-naïve and treatment-experienced patients with or without compensated cirrhosis and those with chronic kidney disease.”

    Read more: FDA approves Harvoni for new uses

    Christine Blank
    Contributing Editor Christine Blank is a freelance writer based in Florida.

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