The high cost of the hepatitis C treatment Sovaldi has caused a steep increase in Medicaid spending, though access to the drug remains extremely limited for low-income patients, reports the Wall Street Journal’s Joseph Walker in an analysis of federal data.

The drug, manufactured by Gilead Sciences, comes at a hefty cost of $84,000 for the course of treatment, or $1,000 per pill.

State Medicaid programs spent $1.08 billion on Sovaldi alone and $1.33 billion on all HCV treatments in the first 9 months of 2014, according to the analysis. As a result, states have started to limit access to only the most severe HCV cases, sparking tension among physicians, patients, and state officials.

Though competition between Sovaldi and AbbVie’s Viekira Pak would allow states to negotiate greater discounts and expand coverage, most states continue to deny access to all but the sickest eligible patients, according to the report.Read the full Wall Street Journal article here .

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