Gilead to no longer pay for meds for people denied by insurance through Support Path
Tig said
Oct 4, 2015
What are you looking for specifically. Try the search function, there are several references to Gilead's programs, agreements and denials. Gilead has information on their website too, www.gilead.com.
Do you have the name of that Broward program for me? I'm very interested in the specific clinic or clinician that can be contacted. Thanks.
Brian1412 said
Oct 4, 2015
Can you source the post ? Harvoni and the agreement with insurance ? Thanks
Tig said
Sep 24, 2015
Thanks Rob, that was real helpful. I appreciate the information...
Brian1412 said
Sep 24, 2015
Getting raw medicine to be made in a bowl in someone's kitchen is dangerous. Getting pissed off at the people who have the treatment isn't really helpfull. The idea is to pent the situation with large numbers so they have to address the need for treatment those of us who have achieved SVR need to help the people coming after and we do it by Prentice a right podition
Brian1412 said
Sep 24, 2015
I have posted many times for people who can't get the treatment in USA to go to the hospitals ,can call the attached health care system and get the person running it on the phone. They will provide the Dr who is running the hep c programs. For a reference we both know. Collier County the social service guy and broward broward general. The are providing the treatment
There are many many others in the usa. Find the hep c support groups they know the who way etc. They will provide the contacts
As far as Europe I have at every stop me twith the advocates. The issue all of them say is the health expenditure. The have blown thu their budgets and we're unprepared for so many who now what the the meds. That has nothing to do with the manufacture. Here in Berlin the have known the scope of the problem the government knew and the are now lobbying strongly to have the government provide whith their obligations
. Indeed advocate for the people on this site but at the same time support for advocacy will take everyone to present a wide range of voices for the cause of getting people treated. It is sgarting.it gets louder but it will take all. It can be done and will ne
Groupergetter said
Sep 23, 2015
Hey Rob, I think what Tig was saying is that the difficulty in getting the meds is a result of problems and costs in many areas. Gilead and other manufacturers wants theirs, the insurance companies want theirs, the dispensing pharmacies want theirs, the doc's, labs, and hospitals want theirs. Sad but it all gets back to the $$$$$$ Don't know what the answer is, what a fine mess. Will take some time to get all those with hcv treated. Sad there will be so much suffering because of the delays in tx.
Tig said
Sep 23, 2015
Guilty of what? How about negligence. Any of them and I honestly don't care which one you like best, if they are denying anyone treatment because of a lesser degree of liver damage, available money or a qualifying program, it's wrong. Simple as that. The programs in place to handle these issues are failing a huge sector of the global population. Now we're witnessing Big Pharm interfering in previously agreed to import/export agreements with third world countries. There are at least 50 countries with high rates of infection that have been denied generic programs and the authorization to develop their own programs by Gilead. Why? Money and market share. They're picking and choosing who to set up their little sweetheart deals with. That should be criminal, it is in my book.
If you have a group that is approving all of these treatment requests, let's have that contact information, please. We are the advocates for our friends and members here. If you have names and numbers, do tell. Thanks...
Brian1412 said
Sep 23, 2015
I am still waiting when people go advocated. Every place I have been and have to wonder why nobody has.
That is where the answer is not making Chinese drugs
Where are your advocates?
Brian1412 said
Sep 23, 2015
So the answer is to make the drugs on a kitchen table. How is that safer..it's not it is dangerous as he'll but the Chinese batch is less dangerous?
Really
Brian1412 said
Sep 23, 2015
Brian1412 wrote:
It is the Insurance Companies. Not the manufacture, not anyone else, it but the Insurance companies. You need the dr. to go to nukes and demand .They are doing it because they THINK they can. Nobody is really arguing the issue except the people who need it
Not that anyone said that Obama care would be the biggest nightmare ever in this Nation, here it is, staring at those who need the meds. The law says, they cannot deny a preexisting condition.
So what are the insurance companies doing? They are denying treatment based on the preexisting condition of the Hep C we all had for some time. . You need to go Ape ,
If you want to try an easier route call your local public Healthcare centers. Ask for the person who runs the Support group. They know how to break the circle and get the meds. Usually for completely free. One has to be an advocate for themselves.
I get an e-mail with number new people getting the meds with this method, and it was 15 alone last Thursday. Average was 6-8 but it is rising by the day. you can get the meds thru these clinics
Brian1412 said
Sep 23, 2015
Guilty of what? You say that the aca left you by so to speak. you went to another to agency who let you down so the answer is some government or some government agency ?
Tig said
Sep 23, 2015
Hey Rob,
A couple of things of note. One, Obamacare does say they can't deny treatment for a pre existing conditon. What it doesn't tell you is if you haven't been treated for the condition, by that doctor, s/he doesn't have to accept you as a new patient, thereby skirting the pre existing treatment requirement. It has happened to me already, it's real. I contacted every doctor in town for a pre existing conditon and not one single doctor would accept a new patient for that conditon. I lost my original doctor because of the ACA. That wasn't supposed to happen either, remember? I ended up going to the VA for help. They treated me for 6 months and then they dropped me! Their excuse? Budget constraints and a revision of their treatment regimen. Right......
Second, check out this post I just left regarding Big Pharma HERE. They're in it just as deep or deeper than the insurance providers. I don't care who it is, if it's connected to profits and their bottom line, they are all guilty...
Must be why I didn't get my cheerleading check this month
Brian1412 said
Sep 23, 2015
It is the Insurance Companies. Not the manufacture, not anyone else, it but the Insurance companies. You need the dr. to go to nukes and demand .They are doing it because they THINK they can. Nobody is really arguing the issue except the people who need it
Not that anyone said that Obama care would be the biggest nightmare ever in this Nation, here it is, staring at those who need the meds. The law says, they cannot deny a preexisting condition.
So what are the insurance companies doing? They are denying treatment based on the preexisting condition of the Hep C we all had for some time. . You need to go Ape ,
If you want to try an easier route call your local public Healthcare centers. Ask for the person who runs the Support group. They know how to break the circle and get the meds. Usually for completely free. One has to be an advocate for themselves.
I get an e-mail with number new people getting the meds with this method, and it was 15 alone last Thursday. Average was 6-8 but it is rising by the day. you can get the meds thru these clinics
Star said
Sep 23, 2015
Tig, thank you for your very informative reply. I'm sorting through all that info and waiting to hear if my husband was able to get anywhere with his Dr. today.
Joanne, I do not believe Express Script is involved, that name is not familiar to me. We are in RI. The first month's supply was delivered by Walgreen's
bubble said
Sep 23, 2015
I doubt Abbvie is doing this. With barely a 15% market share in the buisness. 1B success is practically garenteed.
dharmabum said
Sep 23, 2015
Hi Star,
Is Express Scripts involved in this mix? They dropped Harvoni from their formulary, and possibly a change in policy has triggered their "creative denial" of drug benefits. I went through the same thing with them this past winter and called everyone that could help - my doctor, the insurance company, CT insurace department and state attorney general.
It worked out for me, but it took a lot of persistence on my part to prevail. Best of luck to you both.
Joann
bubble said
Sep 23, 2015
I just got my EOT+12 Dr. visit. Said my Ultrasound showed a smooth and even Liver. Will be concerned about liver cancer now. I go again for a 6 month checkup down the road. He is very amazed with Abbvie. He has had failures with Harvoni. He did not say non responders or relapse. He really opened up and talked of disgust with Gilead. First they rounded up some of the biggest insurance companies,made them their formulary and the pulled the rug out from under them and made Harvoni given under certain levels of disease.
He was so happy at first giving out Harvoni in the begining. Now this. He said Vikera has a better success rate and wishes now to just prescribe it. It's making so much more paperwork and diagnosis for Harvoni only to say "no". It's like I always said about Big Pharma being cut throat. I guess what I am recomending here is to get an insurance company that is assigned Vikera-Pac and insist on it. Just my 2 cents but am hoping others will ask there doctor also about their sucess rates with both. I am just so humble to have had the drugs in my own two hands and got treated.
There is also a all genotype pill comming out next year for all 1's through 6 by Gilead. Lets hope they do the right thing before Washington get's it straight for them.
Tig said
Sep 23, 2015
Hi Star,
Welcome back, I'm glad you checked in. You have had quite a Summer and let me say congratulations on your wedding! I wish you a wonderful life together and it will be, I'm sure.
I'm sorry to hear about your husband's (and yours) dilemma, but not surprised either. These insurance changes are simply ridiculous. They are affecting literally everyone and this next year, I'm told, is going to be more of the same. There are some things I can recommend as a way to get this appeal process started. Your first step of course is to discuss this with the doctor and it sounds like you've gotten that step planned, good. Next, I would make a number of calls, starting with your state insurance commissioner and state legislators. Have all of your paperwork ready for reference and if you have the original approval from BCBS, you're ahead of the game. Once approved they are going to have a hard time explaining themselves to the insurance commissioner. It's all a money play, pure and simple.
Next thing you should do, even as the rest of this process is moving forward, is contact Gilead Support Path. You are insured, so complete coverage is doubtful, but they probably will be able to give some financial advice relying on similar issues they've dealt with. The other thing is to ask them about the Harvoni CoPay Assistance coupon they offer. If you qualify, it can almost eliminate your CoPay. I'll give you a link to that info below. There are other programs on the list I will provide that can assist you in a number of ways, the Pan Foundation being one of them. Don't hesitate to call them, they understand the issues at hand.
Do stay in touch and keep after them. There is always someone in the position to approve this that is but a phone call away. You just have to find the one with two brain cells and a heart. Don't take no for an answer. Prepare your documentation and go after them! Good luck and if I can offer any assistance, let me know.
I haven't been here in a few years. Short re-cap. When I first joined this group it was to seek support for my then boyfriend who was on treatment for Hep C, he was taken off that triple drug combo because it nearly killed him. Fast forward to 2015, he was approved for Harvoni with a $100 per month co-pay for 6 month's treatment. Before he could start treatment, he had a couple of unrelated health issues that forced a delay in treatment.
In the mean time, we were married this summer. He switched to my health insurance plan (we both have Blue Cross but my plan is better). he started the Harvoni which had been covered under his plan. Yesterday, Walgreen's called to arrange delivery of his next batch. They said "OK that will be $6100.00, how do you want to pay?"
There is no way we can afford that even if we lived in the woods and didn't eat for the next five months. Walgreen's is blaming Blue Cross, Blue Cross is blaming Walgreen's. I'm just looking for any insight from all of you knowledgeable people. We are devastated. He is calling his Dr. today.
fourlocos said
Sep 4, 2015
Maybe it was a mistake because my Doctor sure was shocked but I was approved on the first try. He told me be prepared for a few months of appeals etc. He had several people ahead of me.
But I got a phone call within four days saying come pick up your harvoni you were approved for 8 weeks.
I have Blue Cross of IL HMO and was an F1-F2. The doctor thought it could be a mistake and insisted I come right over to pick up the drug and start the next day. Before they figured it out! I know I was blessed.
Bills said
Sep 3, 2015
I'll Have to first say I'm humbled by all this because I did get treated and looks very promising for SVR. I have good insurance but the coupon ran out I was looking a over 10K in copay for the last 2 bottles. Some how I got it without having to pay. I know thats a gift. But being Mr negative I still think of Gilead as the evil greedy pharma. Because of the price and because they wouldn't just stay with the BMS Delacivier and made us wait almost 2 years. My only consolation for that it Ledipisvir is working so well. maybe it really worth the wait.
Insurance Absolutely the real hold up. my friend Bubble knows. He was chasing Harvoni about as long as I have. I was mad that his insurance only gave in to VP. But that's proving to be very successful for the less cirrhotic groups. I have a neighbor that has Hep C long as I did. His ins. outright said NO Harvoni. He has Diabetes, High Blood pressure, Gastro problems, high anxiety, On several Meds. He just had necessary foot surgery waited 2-3 years for. And he had to fight for it. He still has not been approved to treat His Hep C doc doesn't know how to fight and he kept getting denied.
But 100% We are in a bad spot with whats going on with the health care ( insurances ) They have a long list of reasons they feel they don't allow anybody anything Its not just us It's every thing. How can they sleep is right. I hope they don't. My friend used to say when I go to hell I'm going kick Regan all day and all night for ever. I would love to have some names of these evil bastards i'll give them an interferon IV Under endless sunlight Just to get started. I'll say this is all we allow and approve down here
I'll have to stop I shouldn't take up so much space here with my rant. Karma they'll see.
BillS
-- Edited by Bills on Friday 4th of September 2015 04:02:39 AM
Brian1412 said
Sep 1, 2015
Yeah that's one. I don't see where it is evil pharmacy causing the issue. It is scumbag insurance companies who have already been paid via Obama care deal.
There were no issues at clinic in florida. New patients full ride in Broward more by the day
Tig said
Aug 20, 2015
Hey Rob,
The letter you're looking for is the first post on this thread. Look down my brother V ....
I know of a family that the mother who had MS was denied a 14k a month drug. She was tugged around by the insurance company 3 times and finnaly a hearing, where they denied her coverage for the script. The manufactuer stepped in and sued the insurance co. She got her drugs! Greed will make these manufactuers wake up. Make them affordable, or price yourself out of the game. When more cures for HepC enter this will stop.
Brian1412 said
Aug 20, 2015
If someone could help find the Gilead release they put out in the past month or more regarding the insurance companies using path it might be useful. Gilead was not terminating the path, they were shutting down the insurance companies from using it for their denials which they were doing, and rightfully so.
That release is on this forum somewhere .
If insurance companies, who have already shared in the Billions of dollars given by the administration to support O-care choose to deny it's policy holders for a disease that is clearly a pre-existing condition before O-care, that is an issue for the State insurance commissioners and is illegal under the Unaffordable care act. There are advocates working on this issue and they will prevail, but one that is trying to get help with the Harvoni via the Path may have a hard choice to consider, such as killing the policy, which might make sense depending on your income. If you would then qualify, you could get the Path support ...
One other option that I did, and is still working, is to seek your local Hep C support group . If you have not had treatment but are trying, you can get a grant for an outpatient clinic at most of the larger Healthcare systems. Your local Hep C support groups will know how to do it. When your done , repurchase your Health policy again. Just choose another one.
My local support group is getting many into a qualified Dr at these larger healthcare systems, and the Drs can get path support for the meds. It works and many around the country are doing some version of this.
Welcome to Obamacare............
Gracie said
Aug 20, 2015
Hi Cat,
Does your signature say you are F4? Why are they refusing you if you are. They absolutely should not be refusing an F4. Keep fighting! You'll get there and koodos on the class action complaint!
Tig said
Aug 20, 2015
Hey Cat,
Welcome to the crowd! The whole Gilead refusal is of course over money. The insurance companies saw an easy out and almost automatically denied the first and second attempts. They were playing Gilead for millions! Now the only people that are out are the patients. They don't care about much more than themselves. What a pathetic bunch they are. I wonder how some of them sleep at night?
Please keep us informed of your progress toward treatment and your day in court. We're here if you have any questions or just feel like talking! Good luck...
mrcat211 said
Aug 20, 2015
Congrats to all who have been approved and completed treatment! True, Support Path is now saying no.
Have not started yet Harvoni but trying. United healthcare denied, denied again and would not even respond to appeals! Filed a class action complaint today...... a lot of work, Dr.s labs and Fibrosure, Fibroscan etc. I am hopeful that the class action suit may help others from having to go through everything I have gone through.... and get their medications as prescribed by their doctor!
S1jiujitsu said
Jul 13, 2015
I am extremely grateful to have got a Harvoni through My support path back in March, and praise God I'm undetectable. But it saddens me to hear this. My insurance denied me three times. And my support path denied me one before they approved it. The crazy thing is Obama makes it law of the land to get insurance. But then you have a life threatening illness and get denied a medication that cures you. this isn't right. This drug should be accessible to everyone and nobody should have to wait to get treatment when there is a cure. Anyone who is affected by this new change in policy I am truly sorry for this. there needs to be a change . You are all in my thoughts and prayers
Gracie said
Jul 12, 2015
Jaded wrote:
pl1952 wrote:
Redbird - I know exactly how you feel..Grateful beyond belief! I know, I know! :) And you'll continue to feel better!
Gracie -- We are suspecting the inital fibroscan reading back in feb. of last year had to be off somewhat. It worked in his favor, however, as he was approved immediately for treatment...
I don't want to take this thread off-topic...and forgive me everyone if I do this one time...but I noted your husband's remarkable fibroscan recovery also and though WOW! I can only hope for such an improvement so fast. The irony if what you say is true and it got him fast tracked. I sometimes wonder if maybe mine was off as well...especially since my ast/alt ratio is not typical of cirrhosis and that my blood palettes have returned to a low normal. Oh well...I guess I will find out in the future.
Hi Jaded... You know that's what I'm hoping too. Mines 15.5 with my other tests close to normal. My hepa said I was "just on the cusp" and fibroscan is 90% accurate, so it could be a bit high. Either way, successful treatment seems to be bringing down the scores and allowing the liver to heal so awesome for us to hopefully one day be considered non cirrhotic! Amazing isn't it. So much to hope for now.
Brian1412 said
Jul 12, 2015
The politicians, insurance people etc better start understanding. That as these type of meds become more common people are going to want them NOW and the insurance people are going to hsve to provide them as they agreed to do in return for the. Really big buyout of billions . How can they say no to someone who has fought hep c for decades. They wont cover it bc its expensive.? They can't. So they stall. Gillead. Was smart to write. The letter and calling on insurance people to quit using those patients for their mistake of dancing with the devil. Gold star. For evil pharma. Insurance company. Nada.
Jaded said
Jul 11, 2015
pl1952 wrote:
Redbird - I know exactly how you feel..Grateful beyond belief! I know, I know! :) And you'll continue to feel better!
Gracie -- We are suspecting the inital fibroscan reading back in feb. of last year had to be off somewhat. It worked in his favor, however, as he was approved immediately for treatment...
I don't want to take this thread off-topic...and forgive me everyone if I do this one time...but I noted your husband's remarkable fibroscan recovery also and thought WOW! I can only hope for such an improvement so fast. The irony if what you say is true and it got him fast tracked. I sometimes wonder if maybe mine was off as well...especially since my ast/alt ratio is not typical of cirrhosis and that my blood palettes have returned to a low normal. Oh well...I guess I will find out in the future.
-- Edited by Jaded on Sunday 12th of July 2015 10:32:17 PM
Brian1412 said
Jul 11, 2015
Unfortunately. For the insurance. Industry they all signed on aca and they all agreed to the terms aka the huge payoff for the insurance. Industry. Now with the scotus rulling thete is no escape. They must honor thier agreement and the states that took the money have obligation to treat. Says alot that they were using evil pharma to try an end around. And it is a plus evil pharma shut it down..: now the pressure on th insurances companies. To do their job and the states. To do their job.
The good news is thst evil pharma. Is going to continue. The path... thsts a good thing
pl1952 said
Jul 11, 2015
Redbird - I know exactly how you feel..Grateful beyond belief! I know, I know! :) And you'll continue to feel better!
Gracie -- We are suspecting the inital fibroscan reading back in feb. of last year had to be off somewhat. It worked in his favor, however, as he was approved immediately for treatment...
Brian1412 said
Jul 11, 2015
It is important. To note that people without insurance or other means can get the meds thru path
Brian1412 said
Jul 11, 2015
Evil pharma will still provide the meds to people who cant pay.
Remember. The inurance industry was paid. Billions of dollars to go to bed with obamacare. People shouted from the rooftops what going. To happen and here it comes.
People getting denied because. Insurance. Wants to hold that billions. ? Sorry.evil insurance companies...your accepting that money prohibits. That: the supreme. Said so.
Sad part is .the people who have good insurance. Are about to get whacked
Gracie said
Jul 10, 2015
pl1952 wrote:
I, too, was a lucky beneficiary of help from Gilead's Support Path. United Healthcare just refused to pay for treatment. And still to this day, when I saw my Doctor last week in NYC, I asked him how were the denials from insurance companies going. He said a bit better, except with UHC. And I pay for my own health insurance -- it rivals my mortgage payment... :(
I feel like a brand new person today after treatment. Only a short hot several months ago, I felt like I had one foot in the grave....
Your hubby's fibroscan went from cirrhotic 25 to 8.5 after successful treatment? Within 2 years? That is amazing!
Redbird29 said
Jul 10, 2015
pl1952 - I feel extremely fortunate in that I was approved by Support Path last month. My paper work was sent in to them on Thursday June 11th and the following Friday I got the call that I was approved. By the next Wednesday June 24th I had my medication in hand. Were the God's watching over me - oh, yes. If it had been even two weeks later I could have missed the program.
After reading this I did call in my refill right away. Had this fear that they might say "Nope". Thank goodness the will have it to me by next week to round out my 8 weeks. It amazes me everyday how much better I am feeling only 2 1/2 weeks in and am so grateful..........
pl1952 said
Jul 10, 2015
I, too, was a lucky beneficiary of help from Gilead's Support Path. United Healthcare just refused to pay for treatment. And still to this day, when I saw my Doctor last week in NYC, I asked him how were the denials from insurance companies going. He said a bit better, except with UHC. And I pay for my own health insurance -- it rivals my mortgage payment... :(
I feel like a brand new person today after treatment. Only a short hot several months ago, I felt like I had one foot in the grave....
Redbird29 said
Jul 10, 2015
I agree with you Brian on they are trying to wake up the Insurance Companies and the Government. I know that the insurance companies were denying, denying appeals and then people, like myself, applied to Support Path. Insurance companies then figured that if they continued to deny then they don't have to pay at all because Gilead will. It is going to take people getting mad, writing letters to Senators, suing Insurance companies and State Medicaid programs and Medicare to force them to start providing this medication to people. It is another battle and hurdle that people will have to fight - hopefully not a long one.........
Brian1412 said
Jul 10, 2015
They want the insurance people to quit jerking around and pay for the meds.. Remember, they Insurance Companies got a TON of money From Obama which doesn't make an appearance on the drug list . Harvoni.
There is nothing really bad here. They want the insurances companies to quit stalling and cover the treatment thru peoples policies. They have already been paid that VERY large check.
If you don't have insurance they will still provide the meds for those people.. This isn't horrible news. They waking up the insurance people
Redbird29 said
Jul 10, 2015
I found this letter below on another forum and wanted to share with everyone. I just wanted to cry when I read this because I was fortunate enough to get accepted into Support Path on June 11,2015. What really breaks my heart is that this is going to devastate so many people who's insurance denies them. Hope denied again..........
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:
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 payers coverage criteria will no longer be eligible for support via Gileads 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.
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
*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 Gileads 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.
What are you looking for specifically. Try the search function, there are several references to Gilead's programs, agreements and denials. Gilead has information on their website too, www.gilead.com.
Do you have the name of that Broward program for me? I'm very interested in the specific clinic or clinician that can be contacted. Thanks.
Can you source the post ? Harvoni and the agreement with insurance ? Thanks
Thanks Rob, that was real helpful. I appreciate the information...
Getting raw medicine to be made in a bowl in someone's kitchen is dangerous. Getting pissed off at the people who have the treatment isn't really helpfull. The idea is to pent the situation with large numbers so they have to address the need for treatment those of us who have achieved SVR need to help the people coming after and we do it by Prentice a right podition
I have posted many times for people who can't get the treatment in USA to go to the hospitals ,can call the attached health care system and get the person running it on the phone. They will provide the Dr who is running the hep c programs. For a reference we both know. Collier County the social service guy and broward broward general. The are providing the treatment
There are many many others in the usa. Find the hep c support groups they know the who way etc. They will provide the contacts
As far as Europe I have at every stop me twith the advocates. The issue all of them say is the health expenditure. The have blown thu their budgets and we're unprepared for so many who now what the the meds. That has nothing to do with the manufacture. Here in Berlin the have known the scope of the problem the government knew and the are now lobbying strongly to have the government provide whith their obligations
. Indeed advocate for the people on this site but at the same time support for advocacy will take everyone to present a wide range of voices for the cause of getting people treated. It is sgarting.it gets louder but it will take all. It can be done and will ne
Hey Rob, I think what Tig was saying is that the difficulty in getting the meds is a result of problems and costs in many areas. Gilead and other manufacturers wants theirs, the insurance companies want theirs, the dispensing pharmacies want theirs, the doc's, labs, and hospitals want theirs. Sad but it all gets back to the $$$$$$ Don't know what the answer is, what a fine mess. Will take some time to get all those with hcv treated. Sad there will be so much suffering because of the delays in tx.
Guilty of what? How about negligence. Any of them and I honestly don't care which one you like best, if they are denying anyone treatment because of a lesser degree of liver damage, available money or a qualifying program, it's wrong. Simple as that. The programs in place to handle these issues are failing a huge sector of the global population. Now we're witnessing Big Pharm interfering in previously agreed to import/export agreements with third world countries. There are at least 50 countries with high rates of infection that have been denied generic programs and the authorization to develop their own programs by Gilead. Why? Money and market share. They're picking and choosing who to set up their little sweetheart deals with. That should be criminal, it is in my book.
If you have a group that is approving all of these treatment requests, let's have that contact information, please. We are the advocates for our friends and members here. If you have names and numbers, do tell. Thanks...
I am still waiting when people go advocated. Every place I have been and have to wonder why nobody has.
That is where the answer is not making Chinese drugs
Where are your advocates?
So the answer is to make the drugs on a kitchen table. How is that safer..it's not it is dangerous as he'll but the Chinese batch is less dangerous?
Really
Guilty of what? You say that the aca left you by so to speak. you went to another to agency who let you down so the answer is some government or some government agency ?
Hey Rob,
A couple of things of note. One, Obamacare does say they can't deny treatment for a pre existing conditon. What it doesn't tell you is if you haven't been treated for the condition, by that doctor, s/he doesn't have to accept you as a new patient, thereby skirting the pre existing treatment requirement. It has happened to me already, it's real. I contacted every doctor in town for a pre existing conditon and not one single doctor would accept a new patient for that conditon. I lost my original doctor because of the ACA. That wasn't supposed to happen either, remember? I ended up going to the VA for help. They treated me for 6 months and then they dropped me! Their excuse? Budget constraints and a revision of their treatment regimen. Right......
Second, check out this post I just left regarding Big Pharma HERE. They're in it just as deep or deeper than the insurance providers. I don't care who it is, if it's connected to profits and their bottom line, they are all guilty...
Must be why I didn't get my cheerleading check this month
It is the Insurance Companies. Not the manufacture, not anyone else, it but the Insurance companies. You need the dr. to go to nukes and demand .They are doing it because they THINK they can. Nobody is really arguing the issue except the people who need it
Not that anyone said that Obama care would be the biggest nightmare ever in this Nation, here it is, staring at those who need the meds. The law says, they cannot deny a preexisting condition.
So what are the insurance companies doing? They are denying treatment based on the preexisting condition of the Hep C we all had for some time. . You need to go Ape ,
If you want to try an easier route call your local public Healthcare centers. Ask for the person who runs the Support group. They know how to break the circle and get the meds. Usually for completely free. One has to be an advocate for themselves.
I get an e-mail with number new people getting the meds with this method, and it was 15 alone last Thursday. Average was 6-8 but it is rising by the day. you can get the meds thru these clinics
Tig, thank you for your very informative reply. I'm sorting through all that info and waiting to hear if my husband was able to get anywhere with his Dr. today.
Joanne, I do not believe Express Script is involved, that name is not familiar to me. We are in RI. The first month's supply was delivered by Walgreen's
I doubt Abbvie is doing this. With barely a 15% market share in the buisness. 1B success is practically garenteed.
Hi Star,
Is Express Scripts involved in this mix? They dropped Harvoni from their formulary, and possibly a change in policy has triggered their "creative denial" of drug benefits. I went through the same thing with them this past winter and called everyone that could help - my doctor, the insurance company, CT insurace department and state attorney general.
It worked out for me, but it took a lot of persistence on my part to prevail. Best of luck to you both.
Joann
I just got my EOT+12 Dr. visit. Said my Ultrasound showed a smooth and even Liver. Will be concerned about liver cancer now. I go again for a 6 month checkup down the road. He is very amazed with Abbvie. He has had failures with Harvoni. He did not say non responders or relapse. He really opened up and talked of disgust with Gilead. First they rounded up some of the biggest insurance companies,made them their formulary and the pulled the rug out from under them and made Harvoni given under certain levels of disease.
He was so happy at first giving out Harvoni in the begining. Now this. He said Vikera has a better success rate and wishes now to just prescribe it. It's making so much more paperwork and diagnosis for Harvoni only to say "no". It's like I always said about Big Pharma being cut throat. I guess what I am recomending here is to get an insurance company that is assigned Vikera-Pac and insist on it. Just my 2 cents but am hoping others will ask there doctor also about their sucess rates with both. I am just so humble to have had the drugs in my own two hands and got treated.
There is also a all genotype pill comming out next year for all 1's through 6 by Gilead. Lets hope they do the right thing before Washington get's it straight for them.
Hi Star,
Welcome back, I'm glad you checked in. You have had quite a Summer and let me say congratulations on your wedding! I wish you a wonderful life together and it will be, I'm sure.
I'm sorry to hear about your husband's (and yours) dilemma, but not surprised either. These insurance changes are simply ridiculous. They are affecting literally everyone and this next year, I'm told, is going to be more of the same. There are some things I can recommend as a way to get this appeal process started. Your first step of course is to discuss this with the doctor and it sounds like you've gotten that step planned, good. Next, I would make a number of calls, starting with your state insurance commissioner and state legislators. Have all of your paperwork ready for reference and if you have the original approval from BCBS, you're ahead of the game. Once approved they are going to have a hard time explaining themselves to the insurance commissioner. It's all a money play, pure and simple.
Next thing you should do, even as the rest of this process is moving forward, is contact Gilead Support Path. You are insured, so complete coverage is doubtful, but they probably will be able to give some financial advice relying on similar issues they've dealt with. The other thing is to ask them about the Harvoni CoPay Assistance coupon they offer. If you qualify, it can almost eliminate your CoPay. I'll give you a link to that info below. There are other programs on the list I will provide that can assist you in a number of ways, the Pan Foundation being one of them. Don't hesitate to call them, they understand the issues at hand.
Do stay in touch and keep after them. There is always someone in the position to approve this that is but a phone call away. You just have to find the one with two brain cells and a heart. Don't take no for an answer. Prepare your documentation and go after them! Good luck and if I can offer any assistance, let me know.
http://hepcfriends.activeboard.com/t56904226/payment-assistance-programs/?page=1#comment-56904226
I haven't been here in a few years. Short re-cap. When I first joined this group it was to seek support for my then boyfriend who was on treatment for Hep C, he was taken off that triple drug combo because it nearly killed him. Fast forward to 2015, he was approved for Harvoni with a $100 per month co-pay for 6 month's treatment. Before he could start treatment, he had a couple of unrelated health issues that forced a delay in treatment.
In the mean time, we were married this summer. He switched to my health insurance plan (we both have Blue Cross but my plan is better). he started the Harvoni which had been covered under his plan. Yesterday, Walgreen's called to arrange delivery of his next batch. They said "OK that will be $6100.00, how do you want to pay?"
There is no way we can afford that even if we lived in the woods and didn't eat for the next five months. Walgreen's is blaming Blue Cross, Blue Cross is blaming Walgreen's. I'm just looking for any insight from all of you knowledgeable people. We are devastated. He is calling his Dr. today.
Maybe it was a mistake because my Doctor sure was shocked but I was approved on the first
try. He told me be prepared for a few months of appeals etc. He had several people ahead of me.
But I got a phone call within four days saying come pick up your harvoni you were approved for 8 weeks.
I have Blue Cross of IL HMO and was an F1-F2. The doctor thought it could be a mistake and insisted I come right over to pick up the drug and start the next day. Before they figured it out! I know I was blessed.
I'll Have to first say I'm humbled by all this because I did get treated and looks very promising for SVR. I have good insurance but the coupon ran out I was looking a over 10K in copay for the last 2 bottles. Some how I got it without having to pay. I know thats a gift. But being Mr negative I still think of Gilead as the evil greedy pharma. Because of the price and because they wouldn't just stay with the BMS Delacivier and made us wait almost 2 years. My only consolation for that it Ledipisvir is working so well. maybe it really worth the wait.
Insurance Absolutely the real hold up. my friend Bubble knows. He was chasing Harvoni about as long as I have. I was mad that his insurance only gave in to VP. But that's proving to be very successful for the less cirrhotic groups. I have a neighbor that has Hep C long as I did. His ins. outright said NO Harvoni. He has Diabetes, High Blood pressure, Gastro problems, high anxiety, On several Meds. He just had necessary foot surgery waited 2-3 years for. And he had to fight for it. He still has not been approved to treat His Hep C doc doesn't know how to fight and he kept getting denied.
But 100% We are in a bad spot with whats going on with the health care ( insurances ) They have a long list of reasons they feel they don't allow anybody anything Its not just us It's every thing. How can they sleep is right. I hope they don't. My friend used to say when I go to hell I'm going kick Regan all day and all night for ever. I would love to have some names of these evil bastards i'll give them an interferon IV Under endless sunlight Just to get started. I'll say this is all we allow and approve down here
I'll have to stop I shouldn't take up so much space here with my rant. Karma they'll see.
BillS
-- Edited by Bills on Friday 4th of September 2015 04:02:39 AM
Hey Rob,
The letter you're looking for is the first post on this thread. Look down my brother V ....
Here's another link to the letter:
Gilead Letter
I know of a family that the mother who had MS was denied a 14k a month drug. She was tugged around by the insurance company 3 times and finnaly a hearing, where they denied her coverage for the script. The manufactuer stepped in and sued the insurance co. She got her drugs! Greed will make these manufactuers wake up. Make them affordable, or price yourself out of the game. When more cures for HepC enter this will stop.
If someone could help find the Gilead release they put out in the past month or more regarding the insurance companies using path it might be useful. Gilead was not terminating the path, they were shutting down the insurance companies from using it for their denials which they were doing, and rightfully so.
That release is on this forum somewhere .
If insurance companies, who have already shared in the Billions of dollars given by the administration to support O-care choose to deny it's policy holders for a disease that is clearly a pre-existing condition before O-care, that is an issue for the State insurance commissioners and is illegal under the Unaffordable care act. There are advocates working on this issue and they will prevail, but one that is trying to get help with the Harvoni via the Path may have a hard choice to consider, such as killing the policy, which might make sense depending on your income. If you would then qualify, you could get the Path support ...
One other option that I did, and is still working, is to seek your local Hep C support group . If you have not had treatment but are trying, you can get a grant for an outpatient clinic at most of the larger Healthcare systems. Your local Hep C support groups will know how to do it. When your done , repurchase your Health policy again. Just choose another one.
My local support group is getting many into a qualified Dr at these larger healthcare systems, and the Drs can get path support for the meds. It works and many around the country are doing some version of this.
Welcome to Obamacare............
Hi Cat,
Does your signature say you are F4? Why are they refusing you if you are. They absolutely should not be refusing an F4. Keep fighting! You'll get there and koodos on the class action complaint!
Hey Cat,
Welcome to the crowd! The whole Gilead refusal is of course over money. The insurance companies saw an easy out and almost automatically denied the first and second attempts. They were playing Gilead for millions! Now the only people that are out are the patients. They don't care about much more than themselves. What a pathetic bunch they are. I wonder how some of them sleep at night?
Please keep us informed of your progress toward treatment and your day in court. We're here if you have any questions or just feel like talking! Good luck...
Have not started yet Harvoni but trying. United healthcare denied, denied again and would not even respond to appeals! Filed a class action complaint today...... a lot of work, Dr.s labs and Fibrosure, Fibroscan etc. I am hopeful that the class action suit may help others from having to go through everything I have gone through.... and get their medications as prescribed by their doctor!
I am extremely grateful to have got a Harvoni through My support path back in March, and praise God I'm undetectable. But it saddens me to hear this. My insurance denied me three times. And my support path denied me one before they approved it. The crazy thing is Obama makes it law of the land to get insurance. But then you have a life threatening illness and get denied a medication that cures you. this isn't right. This drug should be accessible to everyone and nobody should have to wait to get treatment when there is a cure. Anyone who is affected by this new change in policy I am truly sorry for this. there needs to be a change . You are all in my thoughts and prayers
Hi Jaded... You know that's what I'm hoping too. Mines 15.5 with my other tests close to normal. My hepa said I was "just on the cusp" and fibroscan is 90% accurate, so it could be a bit high. Either way, successful treatment seems to be bringing down the scores and allowing the liver to heal so awesome for us to hopefully one day be considered non cirrhotic! Amazing isn't it. So much to hope for now.
The politicians, insurance people etc better start understanding. That as these type of meds become more common people are going to want them NOW and the insurance people are going to hsve to provide them as they agreed to do in return for the. Really big buyout of billions . How can they say no to someone who has fought hep c for decades. They wont cover it bc its expensive.? They can't. So they stall. Gillead. Was smart to write. The letter and calling on insurance people to quit using those patients for their mistake of dancing with the devil. Gold star. For evil pharma. Insurance company. Nada.
I don't want to take this thread off-topic...and forgive me everyone if I do this one time...but I noted your husband's remarkable fibroscan recovery also and thought WOW! I can only hope for such an improvement so fast. The irony if what you say is true and it got him fast tracked. I sometimes wonder if maybe mine was off as well...especially since my ast/alt ratio is not typical of cirrhosis and that my blood palettes have returned to a low normal. Oh well...I guess I will find out in the future.
-- Edited by Jaded on Sunday 12th of July 2015 10:32:17 PM
Unfortunately. For the insurance. Industry they all signed on aca and they all agreed to the terms aka the huge payoff for the insurance. Industry. Now with the scotus rulling thete is no escape. They must honor thier agreement and the states that took the money have obligation to treat. Says alot that they were using evil pharma to try an end around. And it is a plus evil pharma shut it down..: now the pressure on th insurances companies. To do their job and the states. To do their job.
The good news is thst evil pharma. Is going to continue. The path... thsts a good thing
Redbird - I know exactly how you feel..Grateful beyond belief! I know, I know! :) And you'll continue to feel better!
Gracie -- We are suspecting the inital fibroscan reading back in feb. of last year had to be off somewhat. It worked in his favor, however, as he was approved immediately for treatment...
Your hubby's fibroscan went from cirrhotic 25 to 8.5 after successful treatment? Within 2 years? That is amazing!
pl1952 - I feel extremely fortunate in that I was approved by Support Path last month. My paper work was sent in to them on Thursday June 11th and the following Friday I got the call that I was approved. By the next Wednesday June 24th I had my medication in hand. Were the God's watching over me - oh, yes. If it had been even two weeks later I could have missed the program.
After reading this I did call in my refill right away. Had this fear that they might say "Nope". Thank goodness the will have it to me by next week to round out my 8 weeks. It amazes me everyday how much better I am feeling only 2 1/2 weeks in and am so grateful..........
I, too, was a lucky beneficiary of help from Gilead's Support Path. United Healthcare just refused to pay for treatment. And still to this day, when I saw my Doctor last week in NYC, I asked him how were the denials from insurance companies going. He said a bit better, except with UHC. And I pay for my own health insurance -- it rivals my mortgage payment... :(
I feel like a brand new person today after treatment. Only a short hot several months ago, I felt like I had one foot in the grave....
I agree with you Brian on they are trying to wake up the Insurance Companies and the Government. I know that the insurance companies were denying, denying appeals and then people, like myself, applied to Support Path. Insurance companies then figured that if they continued to deny then they don't have to pay at all because Gilead will. It is going to take people getting mad, writing letters to Senators, suing Insurance companies and State Medicaid programs and Medicare to force them to start providing this medication to people. It is another battle and hurdle that people will have to fight - hopefully not a long one.........
There is nothing really bad here. They want the insurances companies to quit stalling and cover the treatment thru peoples policies. They have already been paid that VERY large check.
If you don't have insurance they will still provide the meds for those people.. This isn't horrible news. They waking up the insurance people
I found this letter below on another forum and wanted to share with everyone. I just wanted to cry when I read this because I was fortunate enough to get accepted into Support Path on June 11,2015. What really breaks my heart is that this is going to devastate so many people who's insurance denies them. Hope denied again..........
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:
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 payers coverage criteria will no longer be eligible for support via Gileads 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.
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
*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 Gileads 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."