Reducing the price of new hepatitis C drugs in the Tuscany region of Italy

In May 2015, the Tuscany region of Italy proposed a regional tendering scheme that extended reimbursement to about 20 000 patients with milder disease.6 This tender will probably close over the next month. This project has been debated among institutions, politicians, patient associations, scientific societies, and experts in the field.3 Opponents (such as the Italian Medicines Agency4) argue that the proposal is not pharmaceutically sustainable; another criticism is that the effectiveness of newer DAAs relies on a surrogate endpoint with no information on long term effects; finally, trying to eradicate this disease locally has been questioned on theoretical grounds. Ethics has been advocated by all stakeholders, but ethics seems to support both prioritising patients with severe disease and ensuring that those with milder, but potentially progressive, disease are treated. The American Association of the Liver recently recommended treating all hepatitis C infected people except those with a life expectancy of less than 12 months due to unrelated conditions.7