Aa
Aa
A
A
A
Close
Avatar universal

Fast insurance coverage?

Insurance Coverage For Emerging Therapies in the Treatment of Hepatitis C Virus







PRNewswire/ --


HealthLeaders-InterStudy and Fingertip Formulary find that only about half (53 percent) of surveyed pharmacy directors expect their health plans to cover both Merck's boceprevir and Vertex/Johnson & Johnson/Mitsubishi Tanabe's telaprevir, when they enter the market for the treatment of the hepatitis C virus.
According to the new report, Formulary Advantages Among Hepatitis C Virus Therapies: Pharmacy Directors Do Not Yet Understand the Pharmacoeconomic Incentives to Cover Emerging Therapies
.


.Hepatitis C Virus Therapies: Pharmacy Directors Do Not Yet Understand the Pharmacoeconomic Incentives to Cover Emerging Therapies, approximately one-third of surveyed pharmacy directors expect to cover one of these drugs, but have not determined which one.

http://hepatitiscnewdrugs.blogspot.com/2010/05/health-plans-to-cover-either-mercks.html
17 Responses
Sort by: Helpful Oldest Newest
Avatar universal
Insurance companies care about their bottom line today, not about saving money in the future.  If curing your Hep C today will keep you from getting cirrhosis 10 or 20 years from now, this is not a big incentive for the insurance company.  10 or 20 years from now, you will probably have insurance with a different company or with Medicare, so your current insurance company is not going to see any future cost-savings benefit from spending thousands of dollars on Hep C treatment now.
Sounds callous, but it's the financial reality.
Helpful - 0
Avatar universal
Thanks Cando

I'll take either one of the PI's and if they aren't out by next year, I'll reconsider Infergen.

Trin
Helpful - 0
179856 tn?1333547362
Well that makes sense I suppose sort of like Interferon Intron vs Peg discussions that we always have. That is why they'd better hussle to get their butts to market - whoever gets there first most likely will have a field day I'd assume, at least at first till we see the comparison in efficacy.

But by then of course they will be developing new drugs that work faster and better and people will start clamoring to hurry up for them. It's the way of the world.
Helpful - 0
1225178 tn?1318980604
According to the new report, Formulary Advantages Among Hepatitis C Virus Therapies: Pharmacy Directors Do Not Yet Understand the Pharmacoeconomic Incentives to Cover Emerging Therapies

It says only 1/3 of the insurance companies will cover these new drugs because they don't "understand the Pharmacoeconomic Incentives to Cover Emerging Therapies." Sounds to me like they need to be EDUCATED... and somebody needs to point out the numbers and how much money they will save treating someone ONE time for 24 months as opposed to treating over and over for 48 to 72 months.

I mean........ it doesn't take rocket science. Who is running those companies anyhow?

Diane
Helpful - 0
Avatar universal
I think you mean weeks.
Helpful - 0
Avatar universal
"I mean........ it doesn't take rocket science. Who is running those companies anyhow? "

The shareholders :-)
Helpful - 0
1225178 tn?1318980604
Oops.....
Helpful - 0
1225178 tn?1318980604
Then the shareholders need a fast course in economics.
Helpful - 0
96938 tn?1189799858
"Pharmacoeconomic"  What a great word!

In prior years, my employer-provided insurance was fast and good.  With coverage reductions and increasing out of pocket costs it is only half fast
Helpful - 0
Avatar universal
"Surveyed pharmacy directors estimate an average of 25% of their beneficiaries who are drug-treated for HCV receive an erythropoiesis stimulating agent (ESA) or granulocyte colony-stimulating factor (G-CSF) to counteract anemia and neutropenia associated with peg-IFN/ribavirn therapy"

We've seen how the PI's can tank blood counts more quickly than SOC.  Hope the insurance companies are on board with helper drugs when the PI's get approved because I think that 25% is going to increase substantially with the PI's.

Trin
Helpful - 0
179856 tn?1333547362
Yes Trin I agree and people who've had bad anemia can tell you it's just not something you can ignore and wish away......it makes treatment itself look like childsplay comparitively.  They HAVE to have availability to them and at the price.....$6,000 for a box of ten - that might offput the insurance companies to even want to risk it.

Ridiculous but true.
Helpful - 0
Avatar universal
Yor right trin on the need for helper drugs, plus the last vertex trial they needed a dermatologist on board, those people that think these insurance companys are going to fall all over themselfs to cover these drugs, well one-third isn't off to a great start.
Helpful - 0
1225178 tn?1318980604
I agree with you. There are so many just on this forum who are not treating because they want to wait for the faster tx and better chances... and many doctors recommending it. I'm concerned that after all that waiting... and their damage getting much worse, their insurance companies still won't pay until they try SOC first.

Diane
Helpful - 0
Avatar universal
I think the insurance companies will get on board pretty quickly. The economics will demand that they do. After all,  they do want their clients to achieve SVR because it's cheaper that way.

My Mother always told me not to borrow trouble and I try very hard not to.

Mike
Helpful - 0
Avatar universal
"My Mother always told me not to borrow trouble and I try very hard not to. "

A very wise woman indeed. I live by that motto.
Helpful - 0
1225178 tn?1318980604
You don't list your age on your profile, but I'm assuming that you are pretty young. Most people find out they are infected after they have been infected 20 years or more. The people that find out sooner are really lucky, but until testing for HCV becomes a routine test, there are going to continue to be lots of people who don't find out until damage has already started in their liver... and they need help when they find out.
Helpful - 0
223152 tn?1346978371
I think this is going to be the job of all the marketing representatives that Vertex is hiring.  If you look on their website at the job offerings, there are many. Some of the requirements are to have a hepatology background.  I don't think the PI companeis have even begun to educate the gastro enterologists but I think they intend to big time.  Lots of jobs for regional sales representatives too.  I think they will hit it hard and I am encouraged by that

Frijole
Helpful - 0
Have an Answer?

You are reading content posted in the Hepatitis C Community

Top Hepatitis Answerers
317787 tn?1473358451
DC
683231 tn?1467323017
Auburn, WA
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Answer a few simple questions about your Hep C treatment journey.

Those who qualify may receive up to $100 for their time.
Explore More In Our Hep C Learning Center
image description
Learn about this treatable virus.
image description
Getting tested for this viral infection.
image description
3 key steps to getting on treatment.
image description
4 steps to getting on therapy.
image description
What you need to know about Hep C drugs.
image description
How the drugs might affect you.
image description
These tips may up your chances of a cure.
Popular Resources
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
Can I get HIV from surfaces, like toilet seats?