At a private meeting for payers and policy makers the other week, the CMO of one of the big PBMs noted that if Gilead Sciences Inc.'s transformational, and transformationally priced, HCV drug Sovaldi sofosbuvir were used in all eligible patients, it would add $1,000 to every health insurance premium in the U.S.

To be fair, that increase would shrink a bit as the treatment prevented down-the-road complications of the disease. But the key point is specialty drugs are now front and center in the mind of the drug decision-maker, whether insurer, physician or patient. And in particular, the people who pay for biotech's products are finally saying "enough."