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JFAC's Bitter Pill

Idaho's Medicaid program is looking for $6.5 million - $1.9 million in state general funds - for its Sovaldi program.


It's called Sovaldi, which is the brand name of a new drug that may be the miracle drug to best treat, and some say cure, hepatitis C. Data presented to the 2013 Conference on Retroviruses and Opportunistic Infections revealed a 100 percent effective rate when the drug was part of a triple regimen, prompting an October 2013 fast-track approval from the Food and Drug Administration. But the breakthrough comes with a budget-busting price tag.

"Your budget always gives me a headache," Idaho Senate Finance Chairman Dean Cameron told Medicaid Administrator Lisa Hettinger.

Cameron's biggest headache was a line item request for $6.5 million—$1.9 million in Idaho general funds and the remainder in spending authority of federal funds—for Medicaid payments for Sovaldi.

"The dollars are significant," he added.

There's good reason that the Sovaldi program for eligible Medicaid recipients has never appeared in an Idaho budget before, let alone surfaced at a hearing of the Joint Finance-Appropriations Committee. Hettinger said the information on Sovaldi was new but very good.

"This drug is able to treat, and potentially cure, what has been a fatal condition," she said.

The cost is astronomical: about $1,000 per pill, or $84,000 for a course of treatment.

"Are there alternatives?" asked Cameron.

Hettinger's answer was news to the Idaho lawmakers in the room but not to the families and friends of those who have died from hepatitis C, which according to the Cleveland Clinic is "one of the most important clinical and public health problems facing modern medicine."

"What happened before?" Hettinger asked rhetorically. "Nothing."

To date, 26 Idahoans have been identified for the Sovaldi program and the current fiscal year is already half over. The target number of patients was 49 for the $6.5 million plan.

"We've made substantial denials to the program," Hettinger said. "A potential participant must be at a chronic level. No alcohol- or drug-use can be present, and the person must have the right genotype to be present."

Sovaldi is only one of the challenges that budget writers must wrestle with in the coming days of the 2015 Legislature, with Medicaid being one of the first state departments to step before JFAC with hat-in-hand.