Medi-Cal’s single highest drug spend on HIV treatment

In State of Reform’s continuing coverage of the United States Senate Finance Committee’s Dec. 15 report on Medicaid drug expenditures by state, we look at the highest line items in Medi-Cal’s fee for service drug program reported for calendar year 2014. According to the report, the state spent over $98 million on Truvada (200mg-300mg tablet), an antiretroviral drug produced by Gilead Sciences, Inc. for the treatment of HIV.

The Senate Finance Committee report provides data on drug reimbursements made by the state against the total number of claims and unique beneficiaries. In addition to Truvada, two other HIV drugs appear in the ten top drug expenditures–Atripla tablet ($79 million) and Stribild tablet ($52 million). Together, these three drugs account for approximately 34 percent of the top ten drug expenditures.

The 18-month investigation led by Committee Ranking Member Ron Wyden (D-Ore.) and Sen. Chuck Glassley (R-Iowa) began in response to Gilead Sciences Inc.’s refusal to issue discounts on the Hepatitis C treatment drug Sovaldi. The Committee reports that the impact of the Gilead’s decision nationally was “Medicaid programs were only able to treat 2.4% of some 700,000 enrollees infected with the disease, despite spending more than $1 billion on the drug during calendar year 2014.”

In California, the state spent an estimated $22 million on 998 claims for Sovaldi 400 mg tablet, earning it the spot of 31st highest drug spend. Harvoni 90-400 mg tablet, also manufactured by Gilead, ranked 164th with a total spend of nearly $3 million.

Medi-cal top ten drugs

Abilify, an antipsychotic used for the treatment of bipolar disorder and schizophrenia appears on the top ten list on five separate lines for a total spend of about $313 million.

 

medi-cal top ten drugs 2The Committee information will impact ongoing discussions about California’s drug prices and sustainability. This month, the Drug Price Relief Initiative led by the AIDS Healthcare Foundation became eligible for the 2016 ballot in November.

The measure claims that it will regulate drug prices by requiring that state agencies pay no more than the lowest price paid for a prescription drug by the U.S. Department of Veterans Affairs. It would apply to “any program where the state is the ultimate payer for a drug, even if the state does not purchase the drug directly.” The measure would include Medi-Cal FFS and CalPERS.