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Hepatitis C Community
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Avatar universal

Getting assistance with Sovaldi on Medicare, Medicaid, etc.

Good news!

For those on Medicare, Medicaid, etc., you CAN get assistance with Gilead's Sovaldi from the Patient Access Network (PAN).

https://www.panfoundation.org/

The specific application is found here:

https://www.panfoundation.org/fundingapplication/index.php?8

Their phone number is 866-316-PANF. You can also apply by phone.

Yay!!  Merry Christmas!

HepCat

...
40 Responses
Avatar universal
For those with private insurance, go to

http://mysupportpath.com OR  https://www.sovaldi.com/register.aspx

for assistance paying for Sovaldi.

HC
...

Avatar universal
https://www.panfoundation.org/hepatitis-c

Hepatitis C Program Status
Open - We are accepting applications for new and renewal patients. If your application for assistance is approved you can begin receiving funding immediately.

Maximum Award Level
$7,000 per year

Eligibility Criteria
1) Patient should be insured and insurance must cover the medication for which patient seeks assistance.
2) The medication must treat the disease directly.
3) Patient must reside and receive treatment in the United States.
4) Patient’s income must fall below 500% of the Federal Poverty Level.

Click here for Federal Poverty Guidelines
http://www.familiesusa.org/resources/tools-for-advocates/guides/federal-poverty-guidelines.html

Get Help With Your Treatment
Apply Online http://www.panfoundation.org/fundingapplication/index.php?7 or call 1-866-316-PANF (7263)

Information About the Disease
Hepatitis C, like other forms of hepatitis, causes inflammation of the liver. The hepatitis C virus is transferred primarily through blood, and is more persistent than hepatitis A or B. High-risk groups are people who inject drugs, people who receive transfusions of unscreened blood, dialysis patients and people who have unprotected sex with multiple sex partners. Hepatitis C is also treated with antiviral medications.

For more information visit the Hepatitis Foundation International website, or call 1-800-891-0707
Avatar universal
The PAN cover both Sovaldi (Sofosbuvir from Gilead) and Olysio (Simeprevir from Janssen)...

Both of these are on the market NOW and many are taking a combo of these off-label.  Talk to your doctor...
Avatar universal
FYI For those on Medicare, Medicaid, etc - Does it have to be added to the "Formulary" of your insurance company?.  Can anyone on Medicare, Medicaid, etc confirm coverage now?

Who on Medicare, Medicaid, etc will get this expensive treatment?  Will there be restrictions that only those who meet certain medical criteria will get it in the near term and others will have to wait?  Will it cover off-label.use?  

The above is required before .panfoundation.org coverage.
1) Patient should be insured and insurance must cover the medication for which patient seeks assistance.







Avatar universal
I would think yes since this is a Baby Boomer disease but I'm trying to see if I can verify that...
Avatar universal
It looks like it depends on who you use for Medicare Part D?  (I'm not on Medicare so this is all new to me.)

According to one Part D provider (Providence), they usually add the drugs on January 1st each year.  That's why Sovaldi and Olysio getting approved in December is good timing.

Can the Formulary change?

Yes, Providence Medicare Advantage Plans may make certain changes to our formulary during the year. Most changes in the formulary happen at the beginning of each year (January 1). However, during the year there may also be changes. For example, the plan might:

Add or remove drugs from the Drug List. New drugs, including new generic drugs may become available or there is a new use for an existing drug. We may remove a drug because it has been found to be ineffective or there may be a drug recall.

Move a drug to a higher or lower cost-sharing tier.

Add or remove restrictions on coverage for a drug. (for more information about restrictions on drug coverage, refer to your Member Handbook/Evidence of Coverage)

Replace a brand-name drug with a generic drug

https://healthplans.providence.org/medicare/pharmacy-medicare-part-d/pharmacy-guidelines-faq/Pages/default.aspx#change

I guess folks should check with their Part D provider...

HC
Avatar universal
I have to sign up for obama care tomorro.. start my treatment in mid january and don't wanna wait any longer..but if anybody has signed up for obama care can you help me out.. trying to get everything with meds don't wanna be turned down somewhere or for something I need because of the obama health insurance I picked..n knda worried finicially how much the meds and treatmnt cost if nebody went thru it w ****** insurance..lmk asap!
1815939 tn?1377995399
I did not sign up for health insurance through the new health exchanges. However, a friend of mine did. This is what he said:

Spent all day reading and comparing the plans in the platinum tier.  All I can say is if you dont know how to do the math you will have a problem!  The lower premium plans will definitely cost you more throughout the year because they have additional % attached to them in out of pocket maximums.  One plan didnt even have an out of pocket maximum.  So the one I chose had  no deductible, $2000 max for medical, and $2000 max for prescriptions, and small copays for Drs."

His plan was in the platinum tier and cost $644 a month. From what I have read, be very careful of any of the plans below the silver tier. They may have lower monthly premiums, but they get you in deductibles and co-pays and other areas of coverage (or lack of coverage). Plus, it appears that there can be Federal help for some if they choose a silver plan instead of a bronze plan.

"Under the law, there are special provisions for lower-income Americans who purchase a silver plan but not a bronze plan. People who earn less than 250 percent of the poverty level – about $28,700 for an individual – get extra help from the federal government in the form of lower copayments for doctor visits and smaller annual deductibles. For the lowest-income residents, that can mean plans with little or no deductible and copayments as small as $3 for primary care doctor visits. “Be very careful before you take a bronze plan over a silver plan” if you are in the subsidy-eligible income range, said Linda Blumberg, a senior fellow at the Urban Institute. Those earning less than twice the federal poverty level, about $23,000 a year for an individual, get the most help, with subsidies ratcheting down sharply after that."

Now that quote is from a newspaper article so I cannot be sure it is accurate. However, keep it in mind when looking for a plan.

http://www.nbcnews.com/health/consumers-beware-not-all-health-plans-cover-doc-visit-deductible-2D11794861

Just be very careful choosing a plan and do the math. One plan may have a low monthly premium and yet have a high deductible and co-pays. That type of plan would cost you a lot more in the long run. One always needs good health insurance because one never knows when something is going to happen or an illness will appear. In addition, you already have Hepatitis C which is an expensive disease to treat. You will have many doctor visits, many lab tests, expensive medications, and possible unforeseen complications or medical needs. In addition, not knowing your liver fibrosis stage, if you have Cirrhosis, you will need to be monitored very closely by a Hepatologist. This all adds up in terms of costs.

So compare the plans closely and do the math. You do not want any financial surprises while you are on treatment. If you have a low income, see if you qualify for the Federal assistance.

Best of luck.
1815939 tn?1377995399
I might add, if you have further questions about Hepatitis C you may wish to start a new thread by gong to the top of the page and clicking on the orange rectangle "Post a Question." Then put in a subject line (title) and ask your question. More people will see it and respond if you start your own thread.
1504401 tn?1387569461
I am on Medicare or rather a Medicare Advantage plan.  The Formulary was released already for 2014 along with addendums and our new med is not on it.  I posted a similar question on medhelp and didn't get an answer directly, responses yes:)...but here is my experience:  I received a phone call yesterday from the specialty pharmacist.  They're working on my paperwork for me, and to get a formulary added takes about 2 to 3 weeks.  If it is approved. I will notify medhelp group as soon as I find out. The government must be made to understand that it is cheaper in the long run to treat the virus.  Please understand that this will only add the formulary for me personally.  you must each go to your doctors or pharmacist now and do this. While we may get lucky and my approval counts for everyone, I certainly would not bank on that if I were you. The formulary will be mailed to you and You can also get a copy on the web. It thoroughly explains how to get a formulary added for your case. Please stay in touch. Janee
Avatar universal
I thought new drugs could be added during the year, as you've stated.  And since everyone has a different Part D plan, is that the reason for doing it individually?

Thanks!
HC
...
Avatar universal
Regarding Solvaldi,

You say that you can receive up to $7000 a year in assistance. Solvaldi is $84,000 for the 12 week program. I don't mean to sound annoyed but how does covering $7000 out of $84,000 help someone with no money?
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