By Sy Mukherjee
April 12, 2018

Striking advances in hepatitis C drug development over the past five years have made the infectious, liver-wasting viral disease a curable one—if you can afford the drugs.

Made by companies like Gilead, AbbVie, Merck, and others, drugs that treat the disease are listed at tens of thousands of dollars in the U.S. But a nonprofit is making its own hepatitis C combination medication that it says is just as effective as those created by for-profit drug giants. And it could cost just $300 for 12 weeks of treatment in poor nations like Malaysia.

The hep C treatment is being developed by the Drugs for Neglected Diseases Initiative (DNDi) in collaboration with Egyptian drug maker Pharco Pharmaceuticals. It combines the generic chemical form of Gilead’s brand name hepatitis C treatment Sovaldi (sofosbuvir) and Pharco’s experimental ravidasvir. Drugs like Sovaldi and its successor Harvoni come with list prices upwards of $84,000 in the U.S. (patients don’t pay that much following rebates and patient assistance programs, but they’re still quite expensive); Gilead, AbbVie, and others have special patient access programs in lower-income countries that slashes those prices significantly for the world’s poor.

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But those programs aren’t available in every nation and, for some, may not go far enough. A more expansively available, cheap option like DNDi’s treatment could theoretically help get millions of more people on treatment—there are about 2.7 million to 3.9 million Americans with chronic hepatitis C, according to the Centers for Disease Control (CDC), but more than 71 million people worldwide are living with the virus. DNDi’s planned pricing would represent a nearly 100% discount to what’s currently available in Malaysia, for instance.

Still, a $300 hepatitis C cure isn’t reality quite yet. While the new mid-stage study results from DNDi were impressive (they showed cure rates of 96% to 97% even for the sickest patients and those with liver scarring), more late-stage trials will be necessary before the drug is available on a large scale in the developing world.

U.S. drug makers are also starting to get diminishing returns from selling their hepatitis C treatments right here in America. So many companies have developed such increasingly effective medicines, such as those that treat more hep C strains with far shorter treatment regimens, that Gilead—a pioneer in the field with Sovaldi and Harvoni—is projecting $3.5 billion to $4 billion in U.S. sales from these kinds of drugs in 2018, a dramatic drop from nearly $13 billion in 2015. AbbVie’s rival Mavyret, for instance, carries a nearly 60% list price discount per month compared to Gilead’s drugs and requires one less month of treatment.

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