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Medicare FORMULARY ADD for SOFOSBUVIR
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Medicare FORMULARY ADD for SOFOSBUVIR

Has anyone ever been involved in getting a medicine added to the "Formulary"?
Curious as to how long it truly takes, as we are waiting for the add of SOFOSBUVIR to cure HCV, in order for Medicare to approve costs.  
Dr. said not before end of year 2013, which is only a couple of weeks away.
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Avatar_m_tn
Check this link out

http://www.medhelp.org/posts/Hepatitis-C/US-Patient-Assistance-Program-/show/2058689#post_9746446

I think this part below will be a big help to those that are on Medicare with part D coverage as that in the past has been a problem for people getting help.

"• Gilead will provide support to the Patient Access Network (PAN) Foundation, an independent non-profit organization that provides assistance for eligible federally-insured and privately-insured patients who need help covering out-of-pocket medication costs."

Good luck
27 Comments Post a Comment
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Avatar_m_tn
Check this link out

http://www.medhelp.org/posts/Hepatitis-C/US-Patient-Assistance-Program-/show/2058689#post_9746446

I think this part below will be a big help to those that are on Medicare with part D coverage as that in the past has been a problem for people getting help.

"• Gilead will provide support to the Patient Access Network (PAN) Foundation, an independent non-profit organization that provides assistance for eligible federally-insured and privately-insured patients who need help covering out-of-pocket medication costs."

Good luck
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When I treated I was on Medicare it did not pay for meds. In the state I live in you got to have a prescription drug plan which I do through Aetna it paid for all mine except my out pocket which max was 5,200. 00 Dollars in any year.  Then it paid it all once you spent out pocket .   I was told in my Dr.   office before I started treatment it be around 100,000.00 with out my prescription drug plan.  The lady in the Dr. office sent out letter to  Aetna to get approval for it and I got approval in about 10 days . But I was treated with Peg and Rib. for 24 weeks.
Good luck all the treatments they  are expensive unless you qualify for help or in a program of some kind.
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I have Aetna Advantage and also receive Extra Help.  Until the drug is part of Medicare's formulary though, we will all be sitting around waiting.
When I get more info from the specialty pharmacy, probably end of next week due to Holiday, I will post for everyone
Having 2b, being a relapser after the Interferon/R gig, and with cirrhosis and Cryoglobulemia, don't want my hubby to borrow against the house since it might be a crap shoot for me.  I am willing to try again, though!  :)  Very exciting.
Thank you..it sure gives me hope.
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Hot diggity.  I certainly will research PAN!  and as stated, let everyone know when I talk to the specialty pharmacist about the Formulary add process.
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Avatar_f_tn
Here's what a friend received when applying for support from Gilead...

"I will not qualify (I filled out these sections on their website). It has nothing to do with income in my case, it has everything to do with my having TriCare and not willing to give up my prescription benefits with them (for everything ELSE I need).

Are the patient's prescriptions paid for in part or in full by any state or federally funded program, including but not limited to Medicare or Medicaid, Medigap, VA, DOD, or TRICARE? YES
yes -- The patient is not eligible at this time. If you have questions, please call 1-855-7-MYPATH (1-855-769-7284).

If the patient begins receiving prescription benefits from such state or federally funded programs at any time, he or she will no longer be eligible to use the co-pay coupon. Does the patient acknowledge his or her agreement with this statement? NO
No The patient is not eligible at this time. If you have questions, please call 1-855-7-MYPATH (1-855-769-7284)."

I hope this has changed now but I got these 3 days ago...

Good luck,

HC

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Avatar_f_tn
Here's the link.  I tried and if you have Medicare, it says you're ineligible...

https://www.sovaldi.com/register.aspx
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Avatar_m_tn
That is why there is PAN.

" Gilead will provide support to the Patient Access Network (PAN) Foundation, an independent non-profit organization that provides assistance for eligible federally-insured and privately-insured patients who need help covering out-of-pocket medication costs."
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Avatar_m_tn
"Access to dedicated case managers to help patients and their providers with insurance-related needs, including identifying alternative coverage options such as federally-insured programs (e.g., Medicaid, Medicare) and health exchanges."

Thanks GILEAD
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Avatar_f_tn
It's the same thing.  The link you provided is a medhelp link that directs folks to mysupportpath.com, which is virtually the same link as https://www.sovaldi.com/register.aspx

This is what happens when you check YES to Medicare...

Are your prescriptions paid for in part or in full by any state or federally funded program, including but not limited to Medicare or Medicaid, Medigap, VA, DOD, or TRICARE?
Yes No
You are not eligible at this time. If you have questions, please call 1-855-7-MYPATH (1-855-769-7284).
If you begin receiving prescription benefits from such state or federally funded programs at any time, you will no longer be eligible to use the co-pay coupon.
Do you acknowledge your agreement with this statement?
Yes No

Contact them at 1-855-769-7284 to verify.

Be careful about giving out misinformation Can-dot .  Check your data, it's old and out-of-date.

HepCat
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Avatar_m_tn
Outdated??? Please!!!

http://finance.yahoo.com/news/u-food-drug-administration-approves-211900093.html;_ylt=Aq0MKm4YMZdUr1WUjn40D3nQtDMD;_ylu=X3oDMTBsYnNqdmNmBGNvbG8DYWM0BHBvcwMyBHNlYwNzcg--
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go to Gilead's site can-dot!  I think that carries more weight than yahoo.com
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Yahoo is just reporting what Gilead is saying.... Can-dot??? Hmmm


Gilead Sciences, Inc. December 6, 2013 4:19 PM

U.S. Patient Assistance Program

Gilead is committed to ensuring that people with hepatitis C can access Sovaldi and has launched Support Path™ (www.MySupportPath.com) to provide assistance to patients who are uninsured, underinsured or who need financial assistance to pay for the medicine. The program consists of an integrated offering of support services for patients and providers, including:
• Access to dedicated case managers to help patients and their providers with insurance-related needs, including identifying alternative coverage options such as federally-insured programs (e.g., Medicaid, Medicare) and health exchanges.
• Education and support, including a 24/7 nursing support service line and the ability to schedule an onsite visit from a clinical educator.
• The Sovaldi Co-pay Coupon Program, which provides co-pay assistance for eligible patients with private insurance who need assistance paying for out-of-pocket medication costs. Most patients will pay no more than $5 per co-pay. Co-pay assistance can also be applied toward deductibles and co-insurance obligations.
• Gilead will provide support to the Patient Access Network (PAN) Foundation, an independent non-profit organization that provides assistance for eligible federally-insured and privately-insured patients who need help covering out-of-pocket medication costs.
• The Support Path Patient Assistance Program will provide Sovaldi at no charge for eligible patients with no other insurance options.  
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Yes I know what it says.  But try actually APPLYING for assistance.  

I thought the same as you: that Gilead's support was open to folks on Medicare.  On another HCV forum, I was informed otherwise & I believed it at face value after reading her post.

But tonight, I went to both Gilead sites, put in first name "Test", last name "Case" and made up an email and mailing address and proceeded to apply.

When I got to the question that says:  

"Are the patient's prescriptions paid for in part or in full by any state or federally funded program, including but not limited to Medicare or Medicaid, Medigap, VA, DOD, or TRICARE?"

and when I checked YES this is the response given (in red letters)

"yes -- The patient is not eligible at this time. If you have questions, please call 1-855-7-MYPATH (1-855-769-7284)."

Sometimes you have to dig deep for the correct info.  

I believed the other HCV site's member info at face value but for this forum; however, I went to both http://www.mysupportpath.com and https://www.sovaldi.com/register.aspx & personally verified all this BEFORE posting my response because I knew that the inevitable squabble would occur here at good ol' medhelp.org.

Which, BTW is getting o...l...d

HepCat
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Avatar_m_tn
"• Gilead will provide support to the Patient Access Network (PAN) Foundation"
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OK, I see they're different.  PAN's website is

https://www.panfoundation.org/

And they WILL help folks on Medicare, Medicaid, etc.

Good news for many folks!
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Avatar_m_tn
It does help if one takes the time to read the WHOLE post.

Can-dot
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I thought PAN was via the Gilead site... not a separate site.  

I did read the WHOLE post but didn't realize it was a separate program.

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Soooo...Can-dot.com is correct
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A link to the correct website would've helped a lot.  I found the website and created a new thread to it to alleviate any further confusion.

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I see that ...and I find that interesting
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I am just glad that janee56 understood it quite well. That was the whole point.

"Hot diggity.  I certainly will research PAN!  and as stated, let everyone know when I talk to the specialty pharmacist about the Formulary add process."
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I don't think I'm the only one who was confused.  I've never seen the PAN site listed anywhere.

I thought if I was confused, and the lady who tried to get help on the mysupportpath.com site was confused, then it was a good bet many more were confused.

So I posted the site to clear up the confusion.

My friend also called and personally talked to the Gilead nurse at the 800 number they give out when you get the ineligible message.  She was not given the PAN website from the nurse.  That's disappointing to hear.  

But all's well that ends well.

HC
...
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Some info from https://www.panfoundation.org/  as of this post

Hepatitis C
Program Status

Open - We are accepting applications for new and renewal patients. If your application for assistance is approved you can begin receiving funding immediately.
Maximum Award Level

$7,000 per year
Eligibility Criteria

Patient should be insured and insurance must cover the medication for which patient seeks assistance.
The medication must treat the disease directly.
Patient must reside and receive treatment in the United States.
Patient’s income must fall below 500% of the Federal Poverty Level.

Drugs on the list include Sovaldi (Sofosbuvir), Ribavirin, Peg Intron RP, Incivek (Telaprevir), Olysio (simeprevir) and Victrelis (boceprevir).

PAN Foundation can consider for payment any co-payment, deductible, or co-insurance amount for medications that are used to treat the disease for which you have been awarded assistance. Medications that treat the side effects of your diagnosis are not covered, and charges for office visits and administration are not typically covered.

Who May Qualify

In order for patients to qualify for co-payment assistance with Patient Access Network, they must meet the following eligibility criteria:

Patient is insured and insurance covers the medication for which the patient seeks assistance.
The medication must treat the disease directly.
Patient's income must be below a designated percentage of the Federal Poverty Level, depending on individual fund requirements.
Patient is prescribed a high cost drug for the disease, depending on individual fund requirements.
Patient must reside and receive treatment in the US.
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Avatar_m_tn
1. When will Sovaldi be added to the "Formulary" for  Medicare or Medicaid, Medigap, VA, DOD, or TRICARE. Just a guess it will be at least a few months.

2. Who will get this expensive treatment?  Will there be restrictions that only those who meet certain medical criteria will get it in the near term and others will have to wait?  We will just have to wait to find out.
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Just saw your comment about we will just have to wait. Please don't.  It will first be handled on a case-by-case.  My understanding since talking to my pharmacist yesterday. We are already working on my approval for the new drug.
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Thank you for your comment I apologize I have not been on the site for very long time. Thankfully I have Extra Help. Hopefully I still have it come January. I also have a Medicare advantage plan so hopefully I'll do okay with my out-of-pocket expenses.  I will know in 2 to 3 weeks whether or not I have approval from Medicare to take the new drug. I will share that news either way and also how much it will cost me. Without insurance the doctor said it's 1200 a pill. Have a great new year and thanks again.
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Approved for Ribavirin yesterday.  I DO still have Extra Help for drug assist on Medicare due to low income.  Anyone on Medicare should check this out.  Call your state's SS Department.
They said next week I should have the Sofosbuvir.  Still in the ADD process of Medicare drug list (Formulary). I saw mention from someone else on a separate post that there were supply issues?  I am in Nevada, and it was not mentioned as being an issue at the specialty pharmacy.
If approved, the cost will be practically nil.
Anyway..that's my update.  in the approval process now 3rd week.  Feeling VERY positive!   Approval for the drug should make a whole lot more sense than letting my liver continue to disintegrate and require a much more expensive transplant.  
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