Hard News by Russell Brown

5

The new Hep C drugs: fresh hopes and old frustrations

My  story on the rollout of the first direct-acting antivirals (DAAs) funded by Pharmac to treat Hepatitis C has been published by Matters of Substance. I filed it a while ago and as journalists do on long lead times, caught myself hoping they wouldn't fix the problem I'd identified before the story came out. They didn't.

This is a story that resonates on several levels: there's the high-level bargaining that Pharmac does on our behalf, and there's the streets and neighbourhoods where 50,000 New Zealanders live with Hepatitis C. And between, there's the community health infrastructure that brings those two worlds together.

It's complicated (read the story), but the short version is that Pharmac has been negotiating with the drug companies making DAAs for some time. Those companies have mostly adopted a radical pricing structure to try and quickly recoup the billions they spent buying and developing intellectual property in their race to market. We're talking $1000 a pill radical.

Late last year, Pharmac tossed away its own August 2015 RFP for the rollout and did a good, unexpected thing. Instead of continuing to negotiate with Gilead for a mass rollout, it struck a deal with another company, AbbVie, which allowed it to fully fund treatment for more than half of the New Zealanders with Hepatitis C. That is: those with Genotype 1 of the virus. Those people will experience what is functionally a miracle cure.

And the people with non-1 genotypes? They need to be on the verge of a liver transplant to quality for Pharmac-funded treatment with Gilead's medicine. But they have options. Amongst the groups sourcing generic DAAs, Fix Hep C Buyers Club has distinguished itself. The drugs it sources are made under licence from Gilead in India. They are the same drugs. And New Zealanders can access them for a private cost of between $1500 and $2000 for a 12-week course.

But the Southern District Health Board doesn't think so. It is holding fast to a refusal to even tell non-1 genotype patients they have the option. No one else I spoke to believes this is an ethical position. It's being taken in a region with a substantial Hep C population. And it's harming lives.

I hope this story shakes up the SDHB. Because it really needs shaking up.

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