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683231 tn?1467323017

Support Path policy changes

I recently ran across some bad news about Support Path on another forum 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.

11 Responses
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Avatar universal
There is a meeting on Thursday for Gilead and the advocates. Although, in the past they have stuck strongly to their guns, we will try, once again, to get them to loosen their policies. Soooooooo frustrating.
Helpful - 0
Avatar universal
They do not lack for nerve!  Set the price out of every normal person's price range,mthen deny treatment if someone's insurnace does or if someone is on government insurance!

There truly is no balm in Gilead!
Helpful - 0
2059648 tn?1439766665
They got the realtime proof thier product works.  
Helpful - 0
Avatar universal
They got the real time proof their product works....and that means what?
Helpful - 0
683231 tn?1467323017
Or maybe Gliead is trying to push the insurance companies do what we pay our insurance to do. To provide us with the medicines we need that our doctors have prescribed for us
Helpful - 0
Avatar universal
While that is a lovely possibility to think about, it doesn't seem like that is the way they operate. Would be nice, though. Fingers crossed. We will see what they say on Thursday.
Helpful - 0
Avatar universal
I just received a letter from my specialty pharmacy, which I had to sign and fax back, telling me that Gilead is fighting my insurance company for payment of Harvoni.  They said it was "medically necessary" to treat with Harvoni and that I did meet the criteria in which BCBS stated in my policy.  It also said even through I received the first 28 pills for free and with no co-pay that I may be held responsible for future co-payments.  And if I didn't sign this paper I may not be eligible to receive future refills of Harvoni.

So I signed this since I had no choice.  I was also willing to pay my out of pockets of expenses which was $12,000.00 with BCBS.  But  since they denied me twice I got them for free....at least for now.  So now I am wondering if I will receive a whopping bill in the mail if they don't come to an agreement with BCBS.
Helpful - 0
2059648 tn?1439766665
Drug companies are in this for the money.  The cost of providing over a six month period free treatment drugs to obtain realtime results……. is minor compared to results obtained.   There was a lot of information gained from this program.   It did help many people who were aware of the program and submitted information timely.    Now its back to business as usual.


http://www.medhelp.org/posts/Hepatitis-C/Public-Health-Groups-Sue-FDA-for-access-to-HCV-clinical-trial-data/show/2649488

Helpful - 0
Avatar universal
Thank you for the info.

RE: "*You are not eligible if you are enrolled in a government healthcare prescription drug program such as Medicaid or Medicare
Part D "

I called today
Support Path for Sovaldi® and Harvoni®, please call 1-855-769-7284, Monday through Friday between 9:00 a.m. and 8:00 p.m. (Eastern Time). -
http://www.gilead.com/responsibility/us-patient-access/support%20path%20for%20sovaldi%20and%20harvoni

This is the summary of my phone conversation with the individual answering my call pertaining to eligibility with governmental healthcare prescription drug program. It is limited by my best recollection and the information provided by the person answering my call.

If anyone is seeking information or help please call the number.

I told the support person that thankfully I was SVR last year 12 weeks SOV/RBV 12 weeks GT2 Cirrhosis well compensated.

That I was seeking information for others asking on a medical self help forum.

results
1. Correct no copay assistance by Gilead’s Patient Assistance Program
however Support Path can provide information about other non drug company Patient Assistance Programs for co-pays for those with a government healthcare prescription drug program who have an approved prescription.

see for two of them
http://www.medhelp.org/posts/Hepatitis-C/Tired-of-waiting-Insurance-issues-Get-help-here/show/2534985

2.  RE "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. "

Support Path may still help those with a government healthcare prescription drug program for the above situation to try and get approval or appeals. (This may be restricted to those who need immediate treatment or ASAP)  

3. For those denied after appeals see 2
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."

if you are enrolled in a government healthcare prescription drug program such as Medicaid or Medicare and are in immediate need (very strict interpretation and criteria after finial denial) may on a very limited individual case by case basis still be considered for free drugs.

Unfortunately some who need immediate treatment may be restricted by the criteria used to apply to  "except those with short life expectancies owing to comorbid conditions" My prayers and support go to them  

NOTE This is not official information and subject to error. Policies may be changed at any time, decisions may be made by individuals and the results may different.  
Helpful - 0
Avatar universal
I just received my first refill on Harvoni via Fed Ex and there was a bill with it and it said I owed $0.00 no charge.  I am in total shock but happy.  Only side effect I have is insomnia.  I can live with that!
Helpful - 0
Avatar universal
That is awesome, I hope everyone manages to get through this sticky coverage web.
Helpful - 0
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