Express Scripts Exec's Elaborate Scheme to Load Up a Cruise Ship in India With Cheap Versions of Gilead Sovaldi

Express Scripts Inc. Exec's Elaborate Scheme to Load Up a Cruise Ship in India With Cheap Versions of Gilead Sovaldi
June 3, 2015
By Alex Keown, and Riley McDermid, Breaking News Staff

ST. LOUIS, Mo. – Drug regimens can be expensive—so much so that one executive with Express Scripts recently floated the idea to a Bloomberg reporter that the company load up an Indian cruise ship with expensive hepatitis C treatments, where the drug can be acquired for about 1 percent of the cost, and sail it to America.

Some treatments for some devastating and chronic illnesses border on the astronomical, sometimes climbing so high that insurance programs may not cover the price. That’s been the case for Gilead Sciences' hepatitis C drug Sovaldi, which can sell for as much as $1,000 per pill, although it can be acquired outside the United States for far less. That’s lead to payor companies to begin thinking creatively about how to get those drugs at a cheaper price—an exercise that has sometimes been perhaps too creative.

Recently Express Scripts Holding Company, a pharmacy benefit management service, dropped coverage of Sovaldi because of the costs. A normal 12-week regimen of the hepatitis C drug has a price tag of about $84,000. One Express Scripts executive actually bandied about the notion of loading up a cruise ship in India with the hepatitis C drug, where the drug can be acquired for about 1 percent of the cost in the U.S., and sailing it to America to provide the drug to those who needed it. Of course, the executive never attempted such a plan due to the laws about selling foreign drugs in the United States, but he told Bloomberg News the market for the treatment demands solutions that “borders on the ridiculous.”

While never a serious notion, Steve Miller, the chief medical officer for Express Scripts made the comment to show how high costs of specialty drugs are keeping them out of the hands of the patients who will benefit the most.

“The point is this: the country is experiencing unprecedentedly high specialty drug costs, and this challenge requires more creative solutions,” David Whitrap, director of communications for Express Scripts, said in an email to BioSpace.

In December, Miller announced a deal with AbbVie to offer their hepatitis C drug Viekira Pak to Express Scripts’ customers at an affordable cost. Unlike Sovaldi, which before it was discontinued by Express Scripts, Viekira Pak will be available to all Express Scripts customers.

“Express Scripts and AbbVie have a single focus: do what’s right for hepatitis C patients. For the first time, a pharmaceutical manufacturer and a pharmacy benefit manager have created an agreement to deliver on the promise of a curative therapy for hepatitis C patients,” Miller said in an article he authored.

Earlier this year news reports showed Gilead sold $10.3 billion of its new hepatitis C drug Sovaldi in 2014.Sovaldi sells for approximately $1,000 per pill, the New York Times reported. Because of its high costs, many employers will not cover the drug in their insurance plans.

In December the Southeastern Pennsylvania Transportation Authority filed a lawsuit against drugmaker Gilead charging the company is abusing its rights as a patent holder “by charging discriminatory prices that apparently have no other rational basis other than to inflate the company's bottom line.” Because of that high price, the transit authority, which paid out $2.4 million for Sovaldi in 2014, said the drug has brought financial harm to the organization.

“Plaintiff, on behalf of itself and those similarly situated, brings this action to stop this unconscionable and unfair conduct, and to secure appropriate recoveries for consumers and third party payors who, like Plaintiff, have been victimized by Gilead’s price gouging scheme,” the transportation agency noted in its lawsuit.

The lawsuit additionally notes Sovaldi can be acquired overseas in countries like India and Egypt, for about $900 per 12-week regimen through generics programs Gilead works with the provide the drug in poorer countries.

Hepatitis C affects about 3.2 million Americans. Sovaldi can treat about 90 percent of those cases.

Gilead is working with governments and insurers to set up patient access in the United States, Bloomberg note, but that has not stopped Americans and others who want the drug to seek it outside the United States through expensive drug trips or through online purchases. Bloomberg reported “more than a dozen Indian drug distributors who say they are selling generic versions of Sovaldi made by Mylan, Cipla Ltd. and Natco Pharma Ltd. for about $1,000 for the 12-week course of therapy. The companies say they will ship the drug worldwide or sell directly to patients who come to India to buy it.”

The U.S. Food and Drug Administration warns consumers against purchasing drugs online, as some may be counterfeit and not contain the effective active ingredients of the regulated drugs.

“Counterfeit medicine is fake medicine. It may be contaminated or contain the wrong or no active ingredient. They could have the right active ingredient but at the wrong dose. Counterfeit drugs are illegal and may be harmful to your health,” the FDA said.

The owner of one website, Silk Road, that sold prescription drugs, as well as illegal narcotics, was recently sentenced to life in prison for his role in drug trafficking.

Harvoni, another HCV medication produced by Gilead sold about $2.1 billion in 2014 and costs about $1,100 per pill. The company said the prices are consistent with the market, the Washington Post reported.

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Will PfizerKline Become the Next Pharma Player?
The speculation surrounding a possible bid from Pfizer Inc. for struggling GlaxoSmithKline is heating up, after one closely-watched biotech analyst said in a note last week that Pfizer buying the company would “unlock access to its balance sheet and improve its tax situation.”

Gregg Gilbert, a biotech analyst at Deutsche Bank, wrote in a note to investors “Introducing PfizerKline” that he thinks a deal would be “materially accretive” for both companies. Gilbert estimated that a bid priced at $29.86 a share, via half stock and half cash, which would push up Pfizer’s earnings per share by 10 percent to 16 percent beginning in 2016.

“We believe that the company has a sense of urgency to create value by leveraging the power of its balance sheet to do needle-moving deals,” Gilbert wrote. “Since media reports in the past have pointed to the potential for a Pfizer/GSK combination, we are revisiting that theme.”

We want to know, dear readers, if you agree? Should Glaxo continue going it alone, or might Pfizer buy it and create one of the world’s largest pharma players in history?

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