A critical drug used to treat hepatitis C that costs $1,000 per pill in the United States costs a mere $4 per pill in India. The generic name of the drug is sofosbuvir, and it is sold in the United States by Gilead Sciences as Sovaldi at a ridiculously marked-up price. But in India, fierce competition due to the country’s widespread outbreak of hepatitis C has driven down the price tremendously.

Gastroenterologist Nirmaljeet Malhi explained, “Manufacturers want more and more patients and are willing to wheel and deal on price. If one agrees to it, the others will also have to. It’s a race where one cannot say no because then they’re going to lose the business.”

Drug companies in India have even started offering discounted disease testing services so that more people can discover that they have hepatitis C. Once they discover that they are infected, the drug makers receive more business. The companies have been known to sponsor disease screening drives, offer free test kits to hospitals and provide bulk discounts to entire villages.

When sofosbuvir first arrived on the market in March of 2015, it cost $10 per pill. But thanks to fierce competition spurred by Gilead, the price is now just a little over $4 per pill. Gilead has been allowing other Indian companies to manufacture and sell the drug in exchange for a portion of their sales. Doctors believe that the price of the drug will continue to fall as drug makers continue to ramp up production.

But the situation is entirely different in the United States, where Gilead maintains the exclusive right to sell the drug. In December of 2013, Gilead Sciences slapped an $84,000 price tag on a 12 week prescription of sofosbuvir, which it calls Sovaldi. Needless to say, consumers were outraged as Gilead clearly took advantage of the limited availability of the medication in the states.

Gilead has said that it “responsibly and thoughtfully” priced Sovaldi for the American market. The company claims that it wants to foster competition in developing countries where most people simply cannot afford American prices, and this is what causes the extreme disparity in costs. Gilead also made the excuse that it offers insurers and bulk buyers discounts in price. Still, this does not do much for Americans who are unable to pay this very high price.

Sofosbuvir is renowned for its ability to treat hepatitis C. It can wipe out an infection in just three months, and it doesn’t bring the debilitating side effects of most other treatments. But unless Gilead Sciences decides to lower its outrageous price tag on this critical medication, it appears that most Americans suffering from hepatitis C will have to stick to traditional treatments.

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