GILD certainly has an edge head to head just based on dosing and no riba (for GT1a patients). On a completey even playing field with somoene else picking up the tab i agree GILD wins. OTOH a cure is a cure and i know i wouldn't wait 2 years (the duration of the express scripts deal) just because i didn't want to take a handful of extra pills a day for 3 months (no higher cure rate) - that makes no sense at all.
i also wonder if the harvoni contracts will mandate 8 weeks for those that qualify. I'd rather get 12 weeks of v-pak, especially GT1b (3-5% higher cure rate trumps any convenience issue IMO)
i do think some docs may still have a bad association with ribavirin from the interferon days, but as combo with DAAs the side effect doesn't seem bad at all (and with experience this stigma will gradually go away IMO)
at the end of the day though it's someone else picking up the tab and with virtually identical efficacy you just take the one your insurance provides without waiting, period end
from a public health standpoint gild willing to chase abbv on pricing is clearly a win - more patinet access to both drugs, including those suckers as you insinuate who are forced into a v-pak since many of them would not have had access to anything if they have earlier stage disease
from a commercial standpoint this is a clear loss for GILD IMO - they may make up most of the lost revenue via increase volume, but that can only last so long and then the treatable market shrinks faster. for ABBV i also think it's probably a net negative, but not clearly so. i think abbv is going to get more revenues early on by discounting (i.e volume will more than compensate for the discount) since as i said on totally equal footing it's hard not to just go with the more convenient regimen (all else equal). the shorter commercial tail though also applies to them, so in the long run i woudl say a slight negative but unclear since later years may ahve more competitors so the thinking of make as much as possible now may make the most sense. enta obviously tracks abbv and frankly if abbv hadn't budged on price i probably would have sold since head to head it would have been tough sledding against GILD
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