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Anyone know if Insurance will pay for these new drugs?

Very exciting news today with my visit to the Hep Dr. - he is going to try to get pre-approval from my insurance company to start me on the 2 new oral drugs (cannot recall the exact names) that you take 1 pill each per day for only 12 weeks with a 90% SVR and minimal side effects.  I have not achieved SVR in 2 prior attempts with the most recent being with triple TX and Incivik which ended last January….am 1b with cirrhosis and 61 years old.  He tells me the plan would cost about $100,000 for the 12 weeks of pills and he is not sure if the insurance companies will approve it.

Anyone else trying this and thinking your insurance might pay?  
67 Responses
Avatar universal
If I am reading this correct he is hoping to be able to go off-label and treat with both Simeprevir and Sofosbuvir together? It is worth a shot as the results of both of these together have had great results across the line.......... Good luck

142526 tn?1397094272
That would be great getting treated off label, if that's your case. What geno type are you?
142526 tn?1397094272
I see you're a 1b, missed that the fist time. It will be interesting to hear what the names of the 2 meds are next time you have a chance to ask.
446474 tn?1446351282
There are many different health insurance plans. The only way to know if your own health insurance plan with cover the treatment drugs and what your co-pay will be is the call them and ask where they are in the process of approving coverage of the drugs. Of course first you have to know what the drugs are that your doctor is proposing to treat you with.

A few corrections:

The new hepatitis C treatments that have now be approved by the FDA require the use of both injectable Peg-interferon and oral Ribavirin in addition to Sovaldi/Sofosbuvir or Olysio/Simeprevir in order to work at this time. These drugs are expected to not require peg-interferon and possibly ribavirin in the future but this is a transition period now. The only all oral treatment (Gilead's) that doesn't use injectable peg-interferon is for genotypes 2 and 3 ONLY.

Just so you don't have unrealistic expectations, there is no new or old treatment for hepatitis C that has an SVR rate of 90% for persons with genotype 1 and cirrhosis.

In Gilead's NEUTRINO study seventeen percent of patients had compensated cirrhosis and 89 percent were infected with genotype 1.
The treatment requires Sovaldi 400 mg once daily in combination with RBV (1,000 or 1,200 mg/day based on patient's weight) and peg-IFN (180 g/week). The SRV rate in "treatment naive" patients with cirrhosis in this study had a SVR rate of 80%. A huge improvement over the 14% SVR rate when using only Peg-interferon + Ribavirin alone which is all we had only a few years ago!

SVR12 Rates in Treatment-Naïve Patients with HCV Genotype 1 Infection (Pooled Data QUEST 1 and QUEST 2) in those with stage 3 and stage 4 (cirrhosis) were 68%.

Best of luck with your treatment.
Avatar universal
YES can-do-man that is exactly what he wants to do.  He said there is no way I should ever go on Riba or Interferon again due to the bad sides.  He travels the globe attending the seminars on all new developments and feels really confident that this will be a success for me and many more.
Avatar universal
Fingers crossed that they will go for it and kudos to your doctor for giving it a shot... It has been done before with other Hep C drugs. Really wishing you the very best as treatment for you at this time is very important... Again, good luck.
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