Hepatitis C pill fight: What will CVS do?

Spokesmen for Gilead and CVS said they had no comment. Other pharmacy managers are watching as well, including Prime Therapeutics LLC, which manages drug benefits for 25 million Americans on various Blue Cross and Blue Shield plans.

David Lassen, Prime's chief clinical officer, said his company has been "actively in negotiations with both drug manufacturers" and "would be open to the possibility" of giving one of the drugs exclusive access to its formulary for genotype 1 patients.

"We are evaluating all aspects of the opportunity as we speak," he said. The company will make a decision by mid- January at the latest, he said. He would not reveal details of which way the company was leaning on how to cover the drugs.

Watching and waiting

Catamaran Corp., which controls about 5 percent of the U.S. market, according to the Department of Labor, is watching as well. "We are waiting for Gilead's response to the current market situation as we continue to establish that available hepatitis C treatments are similar in clinical effectiveness based on independent review," Sumit Dutta, Catamaran's chief medical officer, said in an e-mail.

For the last year, Express Scripts threatened to remove Gilead's pill, Sovaldi, which forms the backbone of the combination of drugs in Harvoni, from its list of covered medicines if an equally effective treatment could be obtained at a lower price. Nonetheless, its rapid decision to give the new AbbVie drug preferred status for patients with the most common U.S. hepatitis C genotype, while excluding the Gilead drugs, was a surprise, Muken said.

"I don't think anyone thought they would move this quickly," Muken said. The Express Scripts deal applies to 25 million patients covered by its main formulary.

'Annoying'

While the lack of choice is "going to be annoying" for doctors, exclusive deals with pharmacy managers may eliminate much of the paperwork and restrictions that have until now made it hard for physicians to get insurance authorization for the hepatitis C drugs, said Bernstein, the Northshore-LIJ doctor.

Mario Molina, the CEO of Molina Healthcare Inc., said that expensive specialty drugs will be a major cause of health-care cost increases in the next two to three years. The company manages Medicaid plans in 11 U.S. states, covering 2.5 million people.

"We have an obligation to look out for the public interest and not squander it on an expensive drug when there is a more cost-effective alternative available," Molina said in a telephone interview. "It is certainly a possibility we could pick one or the other of these two drugs as the preferred drug for these patients."