The Oregon Health Plan, which provides coverage for low-income residents, is recommending that it not cover Gilead’s Sovaldi or Janssen’s Olysio hepatitis C medications.
The Oregonian reports that the program wants to invoke its waiver to bar these medications for cost purposes—providing it for around 33%, or 7,000 of the plan’s members, would cost $168 million a year. As a point of comparison, the plan spent a total of $377 million on medications for its 600,000 members in 2013.
The Oregonian also notes that the state is hemmed in by a 2012 agreement with the federal government which bound the state to cap expenses in exchange for $1.9 billion. Exceeding the cost limits would put the state on the hook for a penalty of hundreds of millions of dollars.
