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Has anyone been denied treatment by Gilead's Support Path?
Brief overview - In November 2014, my doctor prescribed Harvoni for 8 weeks. My insurance company denied it.
Then he prescribed Viekira Pak w/ ribavirin for 12 weeks. My insurance denied that, as well.
Both times, the letters, more or less, stated my numbers didn't meet their requirements for treatment. In other words "I'm not sick enough".
My doctor has sent an appeal letter to my insurance company for Harvoni, this week. If denied, again, my understanding is the next step will be Gilead's Support Path.
For the past 13 years, he has tried to talk me into trying different treatments, which I wouldn't do.
I have had HCV for approximately 40 years & have always chosen NOT to treat, because I didn't want to endure the side effects and quite frankly was afraid to.
When my doctor told me about Harvoni, I felt there was hope in ridding my body of hep c. I was ready, especially since
the sides weren't going to be severe.
My question is - Has anyone ever been denied Harvoni from Support Path?
MG
Then he prescribed Viekira Pak w/ ribavirin for 12 weeks. My insurance denied that, as well.
Both times, the letters, more or less, stated my numbers didn't meet their requirements for treatment. In other words "I'm not sick enough".
My doctor has sent an appeal letter to my insurance company for Harvoni, this week. If denied, again, my understanding is the next step will be Gilead's Support Path.
For the past 13 years, he has tried to talk me into trying different treatments, which I wouldn't do.
I have had HCV for approximately 40 years & have always chosen NOT to treat, because I didn't want to endure the side effects and quite frankly was afraid to.
When my doctor told me about Harvoni, I felt there was hope in ridding my body of hep c. I was ready, especially since
the sides weren't going to be severe.
My question is - Has anyone ever been denied Harvoni from Support Path?
MG
I recently ran across some bad news about Support Path for patients denied by their insurance
Copied below is a letter received
Wednesday, July 1, 2015
Dear Community Partner,
Gilead has always been an advocate for patient access to therapies in the areas in which we work. I am writing to provide you with an update regarding Support Path, our patient support program for individuals living with chronic hepatitis C.
As you may be aware, Support Path is designed to help patients in the U.S. with high co- pays or who lack adequate insurance access Sovaldi or Harvoni. The Support Path program provides assistance to patients who are uninsured or who need financial assistance to pay for the medicine.
Key components of the program include:
• The Sovaldi and Harvoni Co-pay Coupon Program, which minimizes monthly out-of-pocket costs for eligible patients* to as little as $5 per month
• The Support Path Patient Assistance Program, which will provide Sovaldi or Harvoni at no charge for eligible patients
In the interest of facilitating patient access in the period immediately following the launch of Sovaldi and Harvoni, the Gilead Patient Assistance Program (PAP) made these medications available to virtually all patients who met financial and other program requirements. Gilead also implemented significant discounts for its HCV therapies across different payer groups. While many payers responded to these discounts by opening access broadly, some payers have continued to restrict access despite the discounts.
As a result, our PAP criteria enabled continued restrictions by some payers by providing a generous route for them to deny access and refer patients they have chosen not to cover. While we have approved
many of these patients in the past, we feel it is necessary to establish more specific guidelines for patient eligibility. Our PAP was designed to help uninsured patients with the most need, and changes are necessary to remain true to that mission. We believe these changes also will help increase access among those payers who continue to restrict access.
With that in mind, effective July 1, 2015, the following changes will be implemented. Gilead anticipates these changes will not impact the majority of patients helped by our patient support programs.
Specifically, patients who are insured and who do not meet their payer’s coverage criteria will no longer be eligible for support via Gilead’s Patient Assistance Program. Patients who fall within the category of “Insured and Did Not Meet Payer Criteria” are patients whose insurance providers limit access to Sovaldi/Harvoni based on, but not limited to, the following:
• Fibrosis score restrictions
• Preferring or exclusively covering another product on formulary (i.e., Viekira Pak preferred)
• Limiting coverage to a maximum treatment duration or denying subsequent treatment after a patient has failed therapy
• Step-therapy requirements
• Clinical criteria (e.g., psychiatric requirements, drug and alcohol testing)
It is important to note that a very small number of patients fall into this category. Support Path experts will continue to treat each patient case individually and consider a number of variables when assessing patients for our free drug program.
*You are not eligible if you are enrolled in a government healthcare prescription drug program such as Medicaid or Medicare
Part D
For Sovaldi and Harvoni patients who are insured and have been denied coverage by their payer, Support Path can assist patients with the requirements for submitting appeals, peer reviews and understanding the process for in-person hearings if required.
Gilead continues to support open access to hepatitis C therapies – with prescribing decisions made by a physician in partnership with his or her patient. We will continue to work with payers to provide information that conveys the profile of our hepatitis C medications and the benefit of curing individuals living with the virus. We believe that payers should take the responsibility to provide coverage for their insured patients based on the treatment decisions of their healthcare providers.
Through Gilead’s Support Path Program, which provides a comprehensive suite of patient assistance resources, we are committed to our mission of helping patients in financial need access our products, and to ensuring our patient assistance program reaches eligible uninsured patients.
As always, we appreciate the ongoing dialogue with our community partners and look forward to continuing to collaborate with you on efforts to expand access to life-saving therapies.
Best regards,
Coy Stout
Vice President, Managed Markets
Gilead Sciences, Inc.
Copied below is a letter received
Wednesday, July 1, 2015
Dear Community Partner,
Gilead has always been an advocate for patient access to therapies in the areas in which we work. I am writing to provide you with an update regarding Support Path, our patient support program for individuals living with chronic hepatitis C.
As you may be aware, Support Path is designed to help patients in the U.S. with high co- pays or who lack adequate insurance access Sovaldi or Harvoni. The Support Path program provides assistance to patients who are uninsured or who need financial assistance to pay for the medicine.
Key components of the program include:
• The Sovaldi and Harvoni Co-pay Coupon Program, which minimizes monthly out-of-pocket costs for eligible patients* to as little as $5 per month
• The Support Path Patient Assistance Program, which will provide Sovaldi or Harvoni at no charge for eligible patients
In the interest of facilitating patient access in the period immediately following the launch of Sovaldi and Harvoni, the Gilead Patient Assistance Program (PAP) made these medications available to virtually all patients who met financial and other program requirements. Gilead also implemented significant discounts for its HCV therapies across different payer groups. While many payers responded to these discounts by opening access broadly, some payers have continued to restrict access despite the discounts.
As a result, our PAP criteria enabled continued restrictions by some payers by providing a generous route for them to deny access and refer patients they have chosen not to cover. While we have approved
many of these patients in the past, we feel it is necessary to establish more specific guidelines for patient eligibility. Our PAP was designed to help uninsured patients with the most need, and changes are necessary to remain true to that mission. We believe these changes also will help increase access among those payers who continue to restrict access.
With that in mind, effective July 1, 2015, the following changes will be implemented. Gilead anticipates these changes will not impact the majority of patients helped by our patient support programs.
Specifically, patients who are insured and who do not meet their payer’s coverage criteria will no longer be eligible for support via Gilead’s Patient Assistance Program. Patients who fall within the category of “Insured and Did Not Meet Payer Criteria” are patients whose insurance providers limit access to Sovaldi/Harvoni based on, but not limited to, the following:
• Fibrosis score restrictions
• Preferring or exclusively covering another product on formulary (i.e., Viekira Pak preferred)
• Limiting coverage to a maximum treatment duration or denying subsequent treatment after a patient has failed therapy
• Step-therapy requirements
• Clinical criteria (e.g., psychiatric requirements, drug and alcohol testing)
It is important to note that a very small number of patients fall into this category. Support Path experts will continue to treat each patient case individually and consider a number of variables when assessing patients for our free drug program.
*You are not eligible if you are enrolled in a government healthcare prescription drug program such as Medicaid or Medicare
Part D
For Sovaldi and Harvoni patients who are insured and have been denied coverage by their payer, Support Path can assist patients with the requirements for submitting appeals, peer reviews and understanding the process for in-person hearings if required.
Gilead continues to support open access to hepatitis C therapies – with prescribing decisions made by a physician in partnership with his or her patient. We will continue to work with payers to provide information that conveys the profile of our hepatitis C medications and the benefit of curing individuals living with the virus. We believe that payers should take the responsibility to provide coverage for their insured patients based on the treatment decisions of their healthcare providers.
Through Gilead’s Support Path Program, which provides a comprehensive suite of patient assistance resources, we are committed to our mission of helping patients in financial need access our products, and to ensuring our patient assistance program reaches eligible uninsured patients.
As always, we appreciate the ongoing dialogue with our community partners and look forward to continuing to collaborate with you on efforts to expand access to life-saving therapies.
Best regards,
Coy Stout
Vice President, Managed Markets
Gilead Sciences, Inc.
Denied twice by BCBS and support path came through. Received the Harvoni last week. It took me about 6 months of fighting so don't give up.
Good luck!
jules
Good luck!
jules
I am in the middle of the ever changing landscape. My doctor's admin has submitted my situation to Anthem Blue Cross. Denial and denial of appeal. Submitting my situation package to Gilead Support Path today... We shall see... Yes!!! Purvey the Gilead Support Path web link in detail! Do what they say, and know... This landscape (due to cost to insurance companies has created a quickly chaing daily landscape.). Best of luck to all enlightened former....someone. God we are blessed to still be here.
Thank you, I have the form & have spoken to them.
From what I understand there is a process to follow, which includes being denied by the insurance company, the doctor appealing, etc.
My question is has anyone ever been denied Harvoni, after following Support Path's requirements?
MG
From what I understand there is a process to follow, which includes being denied by the insurance company, the doctor appealing, etc.
My question is has anyone ever been denied Harvoni, after following Support Path's requirements?
MG
here is the link for support path just in case you need it or call 1-855-7-MYPATH (1-855-769-7284) to register over the phone.
http://www.mysupportpath.com/
they have their intake form
http://www.mysupportpath.com/~/media/Files/mysupportpath_com/Support_Path_Intake_Form.pdf
My understanding is if your household income is below $100,000.00 / year and you otherwise qualify you should be good to go.
http://www.mysupportpath.com/
they have their intake form
http://www.mysupportpath.com/~/media/Files/mysupportpath_com/Support_Path_Intake_Form.pdf
My understanding is if your household income is below $100,000.00 / year and you otherwise qualify you should be good to go.
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