Formulary Lookup Tool - US drug status for health plans

[JimmyMose]

I found this and it may help you to find insurance companies in your US state .  Registration not require for searching but required to save searches.  This information is consistently being updated some local health care plans shown n/a or none last week now show tier 3 or other for Sovaldi.
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Formulary Lookup Tool
Fingertip Formulary® is a simple-to-use tool that allows you to determine formulary drug status for health plans in your area.
We offer formulary information on the most commonly prescribed drugs. Simply select a drug and health plan and formulary results will be displayed.

http://drg-fingertipformulary.com/

click Formulary lookup tab (lower right side)
1st drug name 2nd state 3rd Medicare-Plans or Non-Medicare-Plans

You must still check with your insurance company to confirm your status and eligibility requirements.

[gibsongal]

i too am trying to figure out if i can get the meds.
the only one that is listed (web site formulary search) under the silver script, medicare part d that i have is the ribavirin.

[Dee1956]

Thank you for the information.  A few days ago the Washington Post had an article about Sovaldi and mentioned that 11 states (under medicare)are not covering this year  Express Script has asked their doctors to hold off on prescribing this medication unless it is needed now.
It further said that HCV is an undeclared public health crises that is killing more people yearly than AIDS.  I thought it was interesting

http://www.washingtonpost.com/national/health-science/costly-hepatitis-drug-sovaldi-rattles-industry/2014/03/01/86cab0b4-a091-11e3-9ba6-800d1192d08b_story.html

[JimmyMose]

LINK ERROR IN COMMENT ABOVE dated Feb 16, 2014
see->  missing l at the end of .htm

Here is the the main link with related sub topics.  You can select from menu on left side
https://www.cms.gov/Medicare/Appeals-and-Grievances/MedPrescriptDrugApplGriev/index.html

[mike716]

Thanks, Jimmy, for the information and sound opinion. I believe you are right on all points.

But is the government (Medicare, Obamacare, Medicaid) going to force people with hep-C to wait until they need a transplant or have liver cancer before they can get the new drugs?

On the other hand, if everyone with hep-C receives the new drugs, payed for by insurance, it could cause serious inflation and, at the very least, a drastic increase in the cost of insurance generally.

The only solution is for the drugs to be sold at a reasonable price, a price that allows the drug companies to make a reasonable but not exaggerated profit and which can be payed without bankrupting individuals or the economy.

What do you think?

Cheers.

Mike

[JimmyMose]

That doesn't mean Sovaldi isn't covered by Medicare
1. The information shown is the latest update reported to them by the insurance plan or gov provider.  
2. Many plans are still evaluating adding Sovaldi to their formulary and many show not covered at this time. Whether it will be added in the future is unknown.(my opinion guess)
3. Some Medicare insurance company plans may be providing Sovaldi at this time only as a on a case by case basis to their more serious need now patients (my opinion guess)

see->
http://www.cms.gov/Medicare/Appeals-and-Grievances/MedPrescriptDrugApplGriev/Exceptions.htm

formulary exception the prescriber's supporting statement must indicate that the non-formulary drug is necessary for treating an enrollee's condition because all covered Part D drugs on any tier would not be as effective or would have adverse effects, the number of doses under a dose restriction has been or is likely to be less effective, or the alternative(s) listed on the formulary or required to be used in accordance with step therapy has(have) been or is(are) likely to be less effective or have adverse effects.

Non-Medicare companies only show a few covered as of now. My guess is similar. .In addition companies are over whelmed with dealing with ACA because close to 4 million new insured have been added. At this time it would by financially impossible to add everyone who wants or is proscribed the new expensive drugs.  The hard decision is determining how serious is the patient's condition that this expensive treatment has to be used now. For some their condition may be so serious that successful treatment chances are too low or would hasten death. For others if their condition indicates they can wait to be treated or treat with the older cheaper drugs if they want. (My opinion)

There are so many companies with so many types of plans in 50 different states. My guess it will be almost impossible at this time to predetermine if you will be covered by any of these plans until
1 You are enrolled  2  Your doctor proscribes the treatment 3 the drug plan agrees to cover it.  4  If you are denied after appeals then apply directly to the drug company.  The drug companies or other agencies may provide some guidance with going through all of these and/or providing financial assistance   (my opinion)

drg-fingertipformulary.com
Formulary Lookup Tool  
IMPORTANT: The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. You are encouraged to contact the prescription drug benefit provider for the most current formulary information.
About Us (excerpt)
Fingertip Formulary® maintains the highest quality and most comprehensive, integrated, database of formulary information in the United States, covering virtually all commercial, Medicare, Medicaid and PBM plans. Our services allow pharmaceutical executives, including brand teams and sales professionals to leverage managed care formulary information as a significant and competitive advantage.

Terms of Use (excerpt)
We do not make any warranty about the accuracy, reliability, completeness, timeliness, or quality of the Web Site or the Content.

mike716, You have been trying hard to figure out a way for you to get the new all oral treatment.  I wish you the best for getting treatment and SVR

[mike716]

Hi, Jimmy.

I went through all the Medicare insurance companies at http://drg-fingertipformulary.com/, and not a single one said it covered Sovaldi. Does that mean Sovaldi isn't covered by Medicare?

I even checked the non-Medicare companies, and only two out of the entire list said they covered it.

Any idea what gives with this?

Thanks.

Mike