Illinois is placing tight restrictions on a new hepatitis C drug that costs $1,000 per pill. Medicaid patients must meet 25 criteria and get prior approval before the government health care program will pay for Sovaldi.
The drug can stop the liver-damaging virus, but it comes with a budget-straining price tag.
Illinois approved the restrictions this month after spending $16 million on Sovaldi this year. Medicaid medical director Dr. Arvind Goyal says the cautious approach was appropriate because there isn't yet enough research on Sovaldi in minority patients and other groups.
But doctors who've seen Sovaldi wipe out the virus say the rules are too limiting. Dr. Steven Flamm of Northwestern University Feinberg School of Medicine says the rules could eliminate most patients he'd like to treat with Sovaldi.
