Paul Scott: How much is a miracle pill worth?

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I was watching the game a while back and feeling like a typical unreachable male customer when an inviting sense of possibility began creeping onto the big screen in my father-in-law's living room.

Had you been there, chances are you, too, would have paused to take in the familiar feeling of good will being created — and from its very first shot of an actor staring off into space while taking shelter from the rain. It was the expert production values and 60-second emotional journey that is the modern TV ad for a new drug.

It's a journey we've all traveled at one time or another, sick or well, no doubt with the worry that we might one day need a new pill ourselves. It starts with the feelings of facing a frightening new illness. Then it shifts to the empowerment that can be ours if we just choose to ask our doctor about the drug in question. Then it eases the passing of time required to hear about various side effects.

The ads work because they start out conveying isolation and fear before rescuing us with new music and a solution that none of us can fault: A person who was once helpless is taking charge of his health once and for all.

In this case, however, the illness was something you rarely hear about during a break in the NBA.


"I don't want to live with the uncertainties of Hep C," came the voice-over. It was a commercial for a drug called Harvoni. Google the pill and you learn that Harvoni treats a deadly serious illness, but one affecting less than one percent of the population.

Why so much effort to sell a drug targeted to so few? Because it costs a lot.

Harvoni costs $1,125 a pill, in fact.

That's not a typo. The drug requires a 90-day course that charges an insurer $94,500. Its manufacturer, Gilead, can't provide a rationale for the price based on Harvoni's production cost. Sovaldi, a similar Gilead drug that cost patients $1,000 per pill, was said to have cost the company just $130 per pill to produce. Gilead even sold the pill to patients in Egypt at $900 for the entire treatment. That's a hundred-fold markdown

What Harvoni does do is cure Hepatitis C in 90 percent of those who take it.

"These drugs have basically revolutionized the treatment of hepatitis C," said Dr. Kymberly Watt, a liver specialist at Mayo Clinic. "This is a cure."

Watt describes the drugs as nothing short of transformative in the care of her patients, a vast improvement over the outcomes and side effects of interferon drugs that preceded them. Mayo insurance pays for them. But you can't say the drugs prevent transplants, because they are becoming standard course of therapy following transplant for patients with hepatitis C.

Gilead made $4.55 billion during the first three months of this year. With revenue from their AIDS drugs, that puts the company on a path to make $29 billion for 2015 — more than three times the revenue for the entire Mayo system last year. So it's no exaggeration to say that we are facing a new era in the way we place value on things in the health care system. As a pair of critics wrote last week in the Star Tribune, "unless something changes, in a few years, we'll spend more on specialty than non-specialty drugs or, for that matter, on doctors."


Some have said the new treatments are worth the price because of the costs of other treatments that they will replace. By that measure, of course, antibiotics have been underpriced for decades and the makers of cortisone should have become billionaires, and dozens of times over.

But they didn't. I know this because one of them lived not far down the street from me, and we would pass his former house while on walks with our dog. It was lovely house, and yet I am just as certain that it probably wouldn't satisfy the makers of a pill seemingly so determined to test our tolerance of a market-based approach to health care. No matter how nice the ad.

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