Paul R. Carter - Executive Vice President, Commercial Operations
President
Hi, Geoff. So several things happened in the quarter in relation to volume and revenue per patient, so maybe I'll try and deal with all of them. So the first thing, as you said, we had, and we expected this and hoped for it, that several of the large commercial payers opened up access to patients regardless of their fibrosis scores during quarter one. The consequence of that was that they triggered discounts that had been previously negotiated in order to incentivize that opening up of restrictions. So that was the first thing. And then the VA, as you know, treated very few patients in quarter four last year because of lack of funding. That funding was agreed for a two-year period and focused on HCV medicines, and was clarified late December. Then the VA went through a process of evaluating the clinical evaluation of product available from not just us, but obviously new entrants to the market. And that process took through till mid to late January. And we had to negotiate with the VA, and we did give the VA some extra discounts, which resulted in them putting our products on their formulary and also opening up, again, access to all patients within the VA. So there were no restrictions on patients. And again, we see this as a large positive. And as that funding got distributed around the VA centers, we started to see a very large uptick in VA treatment from about the middle of the quarter, and we anticipate that that will continue through the year. The second area that happened, of course, is we had the entrance of Merck into the market, and so we judiciously exercised our contractual right to preserve access. And in a few cases, we did increase a little bit of discount to some payers to ensure that Harvoni in particular remained on formularies and with full access. The third thing I think we've seen, as I indicated in the comments, was a slight and gradual shift of payer mix away from the commercial and Medicare Part D payers towards the more government payers, and that was probably about a 10% shift from quarter four to quarter one. And then the final piece, as we indicated, is we did have a catch-up, a true-up of some rebate claims that came in respect to quarter three and quarter four that were a little bit higher than we estimated last quarter and which we put right during quarter one. So that really is the dynamic between volumes and revenue per patient.