PIs and insurance

I was wondering, when PIs will eventually get FDA approval, when will insurance companies cover these drugs? Is it going to be immediately after approval is granted?

I never found myself in this situation before-waiting for experimental drug to become FDA approved.

We have a good government funded insurance-Tricare. They usually don't give us trouble with paying for anything that is not considered experimental.

[nygirl7]

I don't think anybody knows for sure but certainly it's going to be supply and demand and they will tightly control it and make sure it's very expensive - after all they have paid all the money out to get the patents.

Interferon and ribavirin is not experimental yet even with the Berg Study AND Sanchez Tapias Study and Dr. Ira Jacobson on board my insurance (great insurance Aetna) said it was 'experimental' and that they would not provide the meds for me - but that they would give me a transplant later if I needed it.  

I honestly have been thinking about it alot and I don't think they are just going to want to put an addon for the heck of it when people haven't even done SOC yet to see if that works.  Like currently they won't give you Consensus Interferon until you've tried regular interferon.

I don't trust insurance companies - in the end it is ALL about making money and that is that. Like when they deny children chemo meds that have higher rates because there are other options available first.

It's just my gut feeling - they are going to want to make that money back big time.

[nygirl7]

Of course that could all be 100% incorrect but I just wonder that people who have already advanced damage should think about it and whether it's worth waiting too long.  If I was a stage 0 or 1 I wouldn't worry about it at all because there is still plenty of time to find out what's going on.

[GreatBird]

The boceprevir trials have included a 4 week lead-in that's SOC only. It turns out that at least in phase 2, people who did the lead-in did better statistically. It would make some sense for them to treat naive patients with SOC only for 4 weeks and then add the boceprevir if they don't clear by week 4 (or 3--I know there's a lag for getting the PCR done, but they might still be able to do this).

For relapsers and non-responders, it would make sense to allow the full 3 drugs since SOC alone didn't work once, why would it work a second (third, fourth, etc.) time?

Even though it's cheaper not to use the PI it's more expensive to treat someone multiple times for the same disease.

[tashka]

I am not a big fan of insurance companies either, but patients have to pay for treatment somehow. I know that Tricare covers interferon/ribavirin combo.

I think that demand should be high, considering how many people are not successful with SOC right now.

I am surprised at the response of your insurance company. Wouldn't it be cheaper for them to fund treatment than to pay for a transplant? Cost of transplant can be millions of dollars. May I ask, how you paid for your treatment, if insurance refused to pay?

[nygirl7]

Once I had their denial in my hand I went to Jacobson to confirm that according to my research I was doing the right thing (Aetna got me rattled into thinking perhaps I was wrong) then with his word and the denial I contacted Comittment to Care and the drug company gave  me the six months of meds for free.  See the insurance company would pay for PCRs and tests but just not for the drugs themselves.

I got lucky - I'm glad I didn't just say oh then ok or I probably would not be cured today.  Oh and oddly they DID pay for the Procrit (epogen ten vials per box at two shots a week so $6,000 only lasted 5 weeks) - but they wouldn't give me more hep meds.  That is why I don't trust them at all.  I wish I was the only one it happened to but fortunately once I'd read it in here that is how I knew to proceed.

[Rockerforlife]

They proberly said they would pay for the transplant,this way they would save money in the long run,cause it would take years for you to become ESLD

[copyman]

one of the new drugs Telaprevir is applying to the FDA for approval this summer. This process takes some time so it looks like next year we should see it. Once FDA approved Insurance should cover it.

Looks like Telaprevir will be out first and that is good because many feel Telaprevir is the better choice of the two drugs because it offers a shorter course of therapy, 24 instead of 48 weeks.

Best of luck

[tashka]

24 weeks of therapy sounds very, very good.

[Rockerforlife]

Im sure the BOC therapies will  be 24 weeks also...and no rash