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Hep C Discussion Forum -> General Discussion -> Insurance Company Policies on Sovaldi/Olysio
Post Info TOPIC: Insurance Company Policies on Sovaldi/Olysio
Tig


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RE: Insurance Company Policies on Sovaldi/Olysio
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Hi Susan,

Thanks for that list of links. We have a list here and I will add this information to it. We can't have too much of a good thing!! I wish I had known about these programs years ago. It would help greatly if these manufacturers would consider making their products affordable in the first place. The price of good health and life in general shouldn't be limited to those that can afford it...

Tig



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Tig

68yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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suziq


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RE: Insurance Company Policies on Sovaldi/OlysioHepatitis PAP and Co-Pay Programs : Patient Assistance and Co ...
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This is an excellent list of patient assistance programs available for the FDA approved Sovaldi (Gilead) and Olysio (Johnson and Johnson)  All other drugs are still only available through clinical trials at this time in U S.

 

Hepatitis PAP and Co-Pay Programs : Patient Assistance and Co ...

www.hepmag.com/articles/hepatitis_paps_copays_20506.shtml 

SuziQ



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Geno 1A  Age 82 Treatment naive Cirrhotic Told I had liver disease in 1966. Diagnosed as Hep C 1999.Started Merck clinical trial with Riba on 9/9/2013 Week 1 and 2 <25  Weeks 4, 8, 12,16,18 UND.  EOT Jan 14,2014  EOT +12 UND   JULY 1 2014 EOT+24= SVR
Tig


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RE: Insurance Company Policies on Sovaldi/Olysio
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If you're searching for Payment Assistance programs, there is a link in my signature section that links you to the forum thread (Knowledge Section) that lists several available options. Good luck!

Tig



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Tig

68yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

Hep C FAQ   Lab Ref. Ranges  HCV Resistance

Signature Line Set Up/Abbreviations   Payment Assistance

 
suziq


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This is the info on GileadOne program, the Sovaldi Co-Pay Coupon Program, is the low-cost solution Gilead is pushing for the hardest. Under the program, patients are told they will pay no more than $5 in out-of-pocket expenses according to a Gilead spokesperson. But that coupon only applies to patients who have a health insurance program and only covers 20 percent of the catalog price of the drug, or $12,000 of the regimens $84,000 cost.

The phone number to Bristol Myers Program for Olysio is 800-736-0003. 

Check them out. Some people are paying under $25 a month for their meds.

There are other programs for people without insurance as well.

SuziQ

 



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Geno 1A  Age 82 Treatment naive Cirrhotic Told I had liver disease in 1966. Diagnosed as Hep C 1999.Started Merck clinical trial with Riba on 9/9/2013 Week 1 and 2 <25  Weeks 4, 8, 12,16,18 UND.  EOT Jan 14,2014  EOT +12 UND   JULY 1 2014 EOT+24= SVR
patiently_waiting


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OS, thanks for the info. Looks like it would cost me roughly $170/month out of pocket with my policy, assuming I got authorized for it. They'd be on the hook for nearly $60K per month. No wonder they're raising hell.



-- Edited by patiently_waiting on Wednesday 16th of April 2014 10:27:59 PM

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42 yrs old: geno 1b, 23mil VL, ALT/AST 269/94 as of Apr '14.  Got HCV when I was 16.  Relapsed from Peg/Riba twice, last time in '08.  Completed Sol/Oly on 9/2/14, UND as of 10/7/14
OldenSlow


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patiently_waiting wrote:

I'm curious what experiences folks have had in getting approved for the Sovaldi/Olysio combo, given it's off-label.  I've read several reports here of people getting approved and some who haven't.  I'm thinking maybe we can compile a list of who is approving and who isn't.  I'll start the list with one post I read about UHC (please correct me if I'm mistaken).  I'm new here so moderators if this already exists elsewhere or is otherwise inappropriate feel free to take it down. :)

  • UHC - will only approve if geno 1 and there's evidence of stage 3 or 4 fibrosis
  • Cigna - this is what I have...anyone know their policy?
  • Sun Life (Canada) - covers it (I think...correct me if I misunderstood Barnacle)
  • others...

Hi PW and welcome to the forum. With the ongoing cost/coverage chaos, this is proving to be a real can of worms. The various insurors are still trying to get a handle on things, Medicaid's a mess (Texas is already limiting coverage there), Express Scripts is waging a vendetta against Gilead and the future is filled with question marks. More unknowns that knowns, honestly. At least UHC published their treatment guidelines, so you know where you stand with those guys. I have Anthem Bc/Bs and have had no issues, though others have. Cigna's formulary is here:

Cigna Formulary 

They show both Sovaldi and Olysio available as third tier drugs, with prior authorization required. You'd have to refer to your benefit plan for further details. Hoping you can get involved in the trials that SuziQ mentioned. That would be a nice way to sidestep the coverage nonsense.

Best of luck to you.

wayne



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66 y/o male - Geno 1b - F4 cirrhotic dx 2001 - 16 wk treatment w/ Sovaldi/Olysio/Riba - Und @ EOT+24 SVR

 
Barnacle


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patiently_waiting wrote:
Barnacle wrote:

In Canada I am covered by employee health plan (Sun Life) they had no issue approving Tx. Dr says it will be at least a year before publin health plan approves sovaldi and may never approve off-label

Just so you know I had to put my foot down to convince my Dr that my health plan would cover it. He seemed skeptical, nurse went away to make phone calls a minute or so later I'm signing application papers. Tell your Dr what you want.

 Hi Barnacle.  I didn't quite understand...is Sun Life the insurance company who covers you or the place where you're employed?

 Sun Life is my health care insurance company. I work for the Federal Government and this health care is provided to all public service employees. Many of whom are not aware they have one of the best health plans in the country. I was not aware until I saw how easy it was to get very expensive off-label treatment that is not available through the public health care.

 



__________________

57yo male gen 1a since '70s. Fib F3-4 VL >2M Tx started 5 Apr 14 Sov/Oly/Rib

wk 4 UND wk 8 UND, wk 12 EOT UND...keep em coming 24wks UND = SVR!
patiently_waiting


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suziq wrote:

Hi Patiently Waiting,

I would suggest that you call immediately.  The lists fill up quickly.  You can always refuse when/if you get called.  But if the list is filled, any opportunity is lost.  I know Merck will be doing several phase 3 trials there this Spring.  They have had great results  That is the trial I just finished.  And I am SVR now.  They have also done some Gilead trials.  I was refused for that trial  BUT  Gilead did a free biopsy for me.  Turned out I had progressed to cirrhosis and the trial was for non-cirrhotics. Got screened for my Merck trial one day after my 79th birthday.  What a great present.  The coordinator there actually had us come in at midnight so we could be first on the nationwide list.  It was first come/first serve on the slots.  Our names went in one minute after midnight and everyone eligible got a slot.

Getting on the list is the most important thing---you can ask questions later---before you accept the trial offered. There is someplace in Dallas that offered some trials last year, but I don't remember where. 

SuziQ  

 

 Got it, thank you.  EDIT:  Just called...spoke with a very nice lady...she said she wasn't sure if they were taking relapsers or not but she would check and get back to me.  Thanks again, SuziQ, very much for giving me that info.



-- Edited by patiently_waiting on Wednesday 16th of April 2014 08:49:20 PM

__________________

42 yrs old: geno 1b, 23mil VL, ALT/AST 269/94 as of Apr '14.  Got HCV when I was 16.  Relapsed from Peg/Riba twice, last time in '08.  Completed Sol/Oly on 9/2/14, UND as of 10/7/14
suziq


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Hi Patiently Waiting,

I would suggest that you call immediately.  The lists fill up quickly.  You can always refuse when/if you get called.  But if the list is filled, any opportunity is lost.  I know Merck will be doing several phase 3 trials there this Spring.  They have had great results  That is the trial I just finished.  And I am SVR now.  They have also done some Gilead trials.  I was refused for that trial  BUT  Gilead did a free biopsy for me.  Turned out I had progressed to cirrhosis and the trial was for non-cirrhotics. Got screened for my Merck trial one day after my 79th birthday.  What a great present.  The coordinator there actually had us come in at midnight so we could be first on the nationwide list.  It was first come/first serve on the slots.  Our names went in one minute after midnight and everyone eligible got a slot.  These are not double blind trials.  All participants get the meds.  There may be a difference in treatment length depending on your treatment/non-treatment status or cirrhosis status.  Everyone on the trial I did there reached SVR.  

Getting on the list is the most important thing---you can ask questions later---before you accept the trial offered. There is someplace in Dallas that offered some trials last year, but I don't remember where. 

SuziQ  

 



-- Edited by suziq on Wednesday 16th of April 2014 08:40:31 PM

__________________

Geno 1A  Age 82 Treatment naive Cirrhotic Told I had liver disease in 1966. Diagnosed as Hep C 1999.Started Merck clinical trial with Riba on 9/9/2013 Week 1 and 2 <25  Weeks 4, 8, 12,16,18 UND.  EOT Jan 14,2014  EOT +12 UND   JULY 1 2014 EOT+24= SVR
patiently_waiting


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suziq wrote:

Hi Patiently Waiting

Since you live in Texas also, my clinic is doing a number of new clinical trials in the very near future--including trials from Merck (the trial I just finished)

If you live anywhere near Dallas, it is the Texas Clinical Research Institute in Arlington Texas.  817-471-1070  Also, San Antonio does trials as does Houston.  I know that Abbott has done some trials in San Antonio. 

It is nice not to have to deal with insurance and get paid to cure HepC.  The people at my center were really great and stayed involved during my treatment.  When I was rejected for one trial, they found another for me.  I was never made to feel like "just another patient" or that my questions were bothersome.  It was a very positive experience. 

SuziQ 

 Thanks for the info, SuziQ.  I am in the DFW metro area so that may be a good option for me.  I will likely see what my doc has to say and if I'm not given good options I could start looking for a trial.  Are these Phase 3 and participants are guaranteed to get actual meds (not placebo) I assume?



__________________

42 yrs old: geno 1b, 23mil VL, ALT/AST 269/94 as of Apr '14.  Got HCV when I was 16.  Relapsed from Peg/Riba twice, last time in '08.  Completed Sol/Oly on 9/2/14, UND as of 10/7/14
suziq


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Posts: 327
Date:
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Hi Patiently Waiting

Since you live in Texas also, my clinic is doing a number of new clinical trials in the very near future--including trials from Merck (the trial I just finished)

If you live anywhere near Dallas, it is the Texas Clinical Research Institute in Arlington Texas.  817-471-1070  Also, San Antonio does trials as does Houston.  I know that Abbott has done some trials in San Antonio. 

It is nice not to have to deal with insurance and get paid to cure HepC.  The people at my center were really great and stayed involved during my treatment.  When I was rejected for one trial, they found another for me.  I was never made to feel like "just another patient" or that my questions were bothersome.  It was a very positive experience. 

SuziQ 



__________________

Geno 1A  Age 82 Treatment naive Cirrhotic Told I had liver disease in 1966. Diagnosed as Hep C 1999.Started Merck clinical trial with Riba on 9/9/2013 Week 1 and 2 <25  Weeks 4, 8, 12,16,18 UND.  EOT Jan 14,2014  EOT +12 UND   JULY 1 2014 EOT+24= SVR
patiently_waiting


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Posts: 170
Date:
Permalink  
 

Barnacle wrote:

In Canada I am covered by employee health plan (Sun Life) they had no issue approving Tx. Dr says it will be at least a year before publin health plan approves sovaldi and may never approve off-label

Just so you know I had to put my foot down to convince my Dr that my health plan would cover it. He seemed skeptical, nurse went away to make phone calls a minute or so later I'm signing application papers. Tell your Dr what you want.

 Hi Barnacle.  I didn't quite understand...is Sun Life the insurance company who covers you or the place where you're employed?



__________________

42 yrs old: geno 1b, 23mil VL, ALT/AST 269/94 as of Apr '14.  Got HCV when I was 16.  Relapsed from Peg/Riba twice, last time in '08.  Completed Sol/Oly on 9/2/14, UND as of 10/7/14
Barnacle


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In Canada I am covered by employee health plan (Sun Life) they had no issue approving Tx. Dr says it will be at least a year before publin health plan approves sovaldi and may never approve off-label

Just so you know I had to put my foot down to convince my Dr that my health plan would cover it. He seemed skeptical, nurse went away to make phone calls a minute or so later I'm signing application papers. Tell your Dr what you want.


__________________

57yo male gen 1a since '70s. Fib F3-4 VL >2M Tx started 5 Apr 14 Sov/Oly/Rib

wk 4 UND wk 8 UND, wk 12 EOT UND...keep em coming 24wks UND = SVR!
patiently_waiting


Senior Member

Status: Offline
Posts: 170
Date:
Permalink  
 

I'm curious what experiences folks have had in getting approved for the Sovaldi/Olysio combo, given it's off-label.  I've read several reports here of people getting approved and some who haven't.  I'm thinking maybe we can compile a list of who is approving and who isn't.  I'll start the list with one post I read about UHC (please correct me if I'm mistaken).  I'm new here so moderators if this already exists elsewhere or is otherwise inappropriate feel free to take it down. :)

  • UHC - will only approve if geno 1 and there's evidence of stage 3 or 4 fibrosis
  • Cigna - seems to be a covered, 3rd tier medication but not sure what policy is on individual approval yet
  • Sun Life (Canada) - covers it (I think...correct me if I misunderstood Barnacle)

 

EDIT: As I look into this more it seems making a list is a waste of time as there are too many variables. 



-- Edited by patiently_waiting on Wednesday 16th of April 2014 07:17:57 PM



-- Edited by patiently_waiting on Wednesday 16th of April 2014 07:18:42 PM



-- Edited by patiently_waiting on Wednesday 16th of April 2014 10:19:53 PM

__________________

42 yrs old: geno 1b, 23mil VL, ALT/AST 269/94 as of Apr '14.  Got HCV when I was 16.  Relapsed from Peg/Riba twice, last time in '08.  Completed Sol/Oly on 9/2/14, UND as of 10/7/14
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