New treatments and insurance

[48weeks]

There seems to be a lot of posturing between insurance and pharmaceutical companies right now. The insurance companies are saying that the upcoming Hep C treatments are the most expensive treatments they've ever dealt with, and the pharmaceutical companies don't seem to be willing to come down on their pricing. I am lucky enough to have a decent policy through work I do with a state agency, but I'm pretty concerned that those of us who are 1a's, and have a history of non-response or relapse may not have these meds available to us in time to make a difference because it looks like court battles could be brewing, and those always go on forever. Anyone else feeling that way.

[Advocate1955]

So, the hepa did appeal the decision and the insurance company (Regence) did deny both of the appeals.  He saw his hepa in June and his liver is still compensated and liver function is still good, no signs of HCC.  I don't know if she'll appeal with the insurance company again, or just wait until new meds (sovaldi/ledipasvir) come out later this year.
Advocate1955

[48weeks]

My GI and the Hepatologist I see both say I am not a candidate for off label S&O and I think it's because they don't want to deal with the endless appeal process. I understand that,  but at the same time I think it's pretty crappy that it has to come to that.

[Advocate1955]

My husband is a prior non-responder to 3 previous treatments, most recent Triple tx with Incivek.   G1a.  Cirrhosis.  His hepatologist wrote a prescription for Sovaldi-Olysio, and his insurance company denied it stating that it was investigational for prior non responders to Incivek.  After the good results on this combo for prior non responders came out after EASL in London in April, his hepatologist appealed the insurance company's decision.  Yesterday we received a letter stating that the insurance company has denied the appeal.  The reason stated was, "we uphold our previous decision".
We're just waiting to hear from the hepatologist what she would like to do next.  Appeal again, or wait for Sovaldi-Led.  I imagine she'll call us next week.  If not, his next 6 mo check up with her is June 5th.
Advocate1955

[Pamelajean1]

I'm actually seeing the opposite...people being approved in days as opposed to months. I'm hearing of more docs that are relying on the recommendations by HCVguidelines.org AND insurance companies that have updated their criteria for approval of 'off label' tx.
I do agree that we have a long way to go for media support and HCV 'coming out of the closet'...ie walks/fundraisers/etc. I'm sure it didn't happen overnight or soon enough during the HIV epidemic either...
Gilead continues to promote their Support Path and IMO has been very proactive in assisting and even providing Sovaldi. Per Gilead.com....

Support Path™ assists eligible hepatitis C patients in the United States who do not have insurance, are underinsured or who otherwise need financial assistance to gain coverage for or access to Sovaldi® (sofosbuvir). The program consists of an integrated offering of support services for patients and providers, among them:

Access to dedicated case managers to help patients and their providers with insurance-related needs.
Education and support, including a 24/7 nursing support service line.
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.
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.
To learn more about Support Path for Sovaldi®, please call, call 1-855-769-7284, Monday through Friday between 9:00 a.m. and 8:00 p.m. (Eastern).

- See more at: http://www.gilead.com/responsibility/us-patient-access/support%20path%20for%20sovaldi#sthash.rPb2IL3Z.dpuf

[hepc4Sandi]

Yes I do, actually was just having this conversation yesterday. Having finishing Tx 2 1/2 weeks ago, I too feel very fortunate, but I am feeling angry that some people on this forum, and others I know can't get the treatment. There are plenty of other programs to help hiv aids patients and other diseases. Fundraisers and walks, etc. We need to pay this forward, I was actually going to give Gilead a call and see what can be done to help others lees fortunate, see if anything has been set up yet.