I wasn't surprised to see Gilead bid up through the day, and was even less surprised to see it drop after hours. Now premarket,(-6%) it is down further. It seems more obvious that it can only lose share in HCV, that the prices will come down, and that payers can comfortably withhold starts. Epclusa and the soon to be approved triple therapy will help, but one can see the trajectory of spending in HCV.
...What will happen with the approval of Abbvie's G/P?
This will be the only approved 8 week program, other than Harvoni for select groups. It will be the only pan-genotypic program.
Presumably, 8 weeks will cost less than 12 weeks of other programs, it won't require genotype testing, or the monitoring of labs like Zepatier requires. G/P is simple enough that it will be more suitable for medicare/ medicaid/ prison and mass payers. It will probably require the least amount doctor education/competency to get good results, whereas in the past treating the disease required specialists; no longer.
G/P could flip the prescriptions more than is expected. Harvoni was once the easiest to prescribe- G/P could replace that; no riba, shortest treatment, very low AE profile, pangenotypic; one treatment for all genotypes (non-cirrhotic naives). Gilead now only has an 8 week program in one genotype; G-1.(but to be fair, pretty competitive results in G-1)
So what happens in the USA when G/P is approved for G-1? That is coming soon, followed by all genotypes. I do not think this will bode well for GILD. What will their 2017 HCV revenues look like? IMHO, it could be worse than estimates.
What about Abbvie-Enta? So it seems that the cost of treatment is coming down, but look at the revenues that Gilead forecasts. There is still lots of money in HCV, and still lots of patients in the USA to be treated. The cost of treatment and market share will be interesting to watch. Gilead did not forecast much drop in pricing, but OTOH both GILD and Abbvie were surprised in the aggressive MRK discounting of Zepatier.
I can see why ENTA chose to not further develop their cyclophilin inhibitor. Treatments are too successful, and prices keep coming down.
The question may be whether others will decide to not develop further programs and how much pricing will be affected.
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