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Hep C Discussion Forum -> Hep C News -> Express Scripts Drops Harvoni 12/2014
Post Info TOPIC: Express Scripts Drops Harvoni 12/2014
Harvoninme


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RE: Express Scripts Drops Harvoni 12/2014
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suziq wrote:

Just as an aside--I just got a letter from my insurance company telling me what brands of diabetic testing supplies they will pay for. 

Are the insurance companies going to determine what drugs (or supplies) that we use instead of our doctors? Interesting development.

SuziQ

 I was thinking the same thing...



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suziq


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Just as an aside--I just got a letter from my insurance company telling me what brands of diabetic testing supplies they will pay for. 

Are the insurance companies going to determine what drugs (or supplies) that we use instead of our doctors.  Interesting development.

SuziQ



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pamelajean


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According to the new AASLD guidelines, the Abbvie 3D regimen is NOT recommended for those who failed the PIs....so it appears Harvoni will still be available with Exprees if what they say is true. "Patients who are already on the drugs will still be covered, and those with other types of hepatitis C and advanced liver disease can still get Sovaldi." 

-----------------
Recommended regimen for patients without cirrhosis who have HCV genotype 1 infection, regardless of subtype, in whom a prior PEG-IFN, RBV, and HCV protease inhibitor regimen has failed. 

Daily fixed-dose combination ledipasvir (90 mg)/sofosbuvir (400 mg) for 12 weeks is recommended for retreatment of patients without cirrhosis who have HCV genotype 1 infection, regardless of subtype, in whom a prior PEG-IFN, RBV, and HCV protease inhibitor regimen has failed. 

Rating: Class I, Level A 

Two options with similar efficacy in general are recommended for patients with cirrhosis who have HCV genotype 1 infection, regardless of subtype, in whom a prior PEG-IFN, RBV, and an HCV protease inhibitor regimen has failed. 

Daily fixed-dose combination ledipasvir (90 mg)/sofosbuvir (400 mg) for 24 weeks is recommended for retreatment of patients with cirrhosis who have HCV genotype 1 infection, regardless of subtype, in whom a prior PEG-IFN, RBV, and HCV protease inhibitor regimen has failed. 

Rating: Class I, Level A 

Daily fixed-dose combination ledipasvir (90 mg)/sofosbuvir (400 mg) plus weight-based RBV (1000 mg [75 kg]) for 12 weeks is recommended for retreatment of patients with cirrhosis who have HCV genotype 1 infection, regardless of subtype, in whom a prior PEG-IFN, RBV, and HCV protease inhibitor regimen has failed. 

Rating: Class IIa, Level B 

 

The following regimens are NOT recommended for patients with HCV genotype 1 infection, in whom prior treatment that included an HCV protease inhibitor has failed. 

    Any regimen containing PEG-IFN, including 

        Simeprevir, PEG-IFN, and RBV 

        Sofosbuvir, PEG-IFN, and RBV 

        Telaprevir or boceprevir, PEG-IFN, and RBV 

        PEG-IFN and RBV alone 

    Rating: Class IIb Level A 

    Monotherapy with PEG-IFN, RBV, or a direct-acting antiviral 

    Rating: Class III, Level A 

    Any interferon-free regimen containing an HCV protease inhibitor 

        Simeprevir 

        Paritaprevir 

    Rating: Class IIb, Level A 


http://hcvguidelines.org/full-report/retreatment-persons-whom-prior-therapy-has-failed



-- Edited by pamelajean on Monday 22nd of December 2014 02:48:18 PM

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pamelajean


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skewedButNotBroken wrote:

Great news! I wonder if those limited to Obama Care will be able to get a piece of this action?

 https://www.express-scripts.com/services/physicians/medicare/

Express Scripts Medicare Formulary

The Express Scripts Medicare Part D formularies are reviewed by a Pharmacy & Therapeutics Committee composed of physicians and pharmacists who have been approved by the Centers for Medicare & Medicaid Services (CMS).

The formulary is a list of the prescription drugs that are approved for coverage under the Express Scripts Medicare Plan. Be sure to select the formulary that applies to the member's plan option.

View the Formulary Changes for Express Scripts Medicare Part D Prescription Drug Plans

View the list of drugs that have quantity limits, step therapy, or prior authorization requirements and the rules that apply to each drug.

Value Plan:

Choice Plan:

Coverage Determination and Redetermination

To initiate the coverage review process or to initiate an appeal of a previously declined coverage review request, please use the resources below.

If you would like to request a coverage determination (such as an exception to the rules or restriction on our plan's coverage of a drug) or if you would like to make an appeal for us to reconsider a coverage decision, you may contact us via phone, mail or fax:

Initial Coverage Decision and Appeals
Use this contact information to initiate the coverage review process.
Phone (toll-free):1.800.935.6103
24 hours a day, 7 days a week.
TTY Users (toll-free):1.800.716.3231
Fax the appropriate
form to:		1.877.329.3760
Mail the appropriate
form to:		Express Scripts
Attn: Medicare Reviews Department
PO Box 66571
St. Louis, MO 63166-6571


-- Edited by pamelajean on Monday 22nd of December 2014 02:50:27 PM

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skewedButNotBroken


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RE: Express Scripts Drops Harvoni 2/2014
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Great news! I wonder if those limited to Obama Care will be able to get a piece of this action?



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pamelajean


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http://mobile.businessweek.com/news/2014-12-22/express-scripts-shuns-gilead-in-hepatitis-c-deal-with-abbvie

"In exchange for its discount, AbbVie gets a guaranteed market for its drug without limitations on the extent of liver damage patients must have before Express Scripts will approve coverage. In addition to specialists, primary-care doctors will be able to prescribe Viekira Pak under the agreement, broadening the market for AbbVie. The deal lets everyone with hepatitis C be treated, Miller said.

In addition to Gileads medications, Express Scripts excluded Johnson & Johnson (JNJ)s Olysio from the national formulary. Patients who are already on the drugs will still be covered, and those with other types of hepatitis C and advanced liver disease can still get Sovaldi." 

 

 



-- Edited by pamelajean on Monday 22nd of December 2014 12:55:14 PM

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pamelajean


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Express Scripts Drops Harvoni 12/2014
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http://www.reuters.com/article/2014/12/22/express-scripts-abbvie-hepatitisc-idUSL1N0U50M120141222&#160;

Dec 22 (Reuters) - The nation's largest pharmacy benefit manager has lined up a cheaper price from AbbVie Inc on its newly approved hepatitis C treatment and, in most cases, will no longer cover Gilead Sciences Inc treatments, Express Scripts said on Monday. 

Express Scripts has opposed the $84,000 pricetag of Gilead Sciences' Sovaldi treatment since it was approved a year ago, saying that was unaffordable. The $1,000 a day pill opened a national debate about drug prices and increased insurer pressure on drug makers to cut prices. 

AbbVie, whose Viekira Pak drug was approved on Friday by U.S. regulators, has set a significantly lower price, Express Scripts Chief Medical Officer Steve Miller said in an interview. 

The pricing agreement covers Express Scripts' National Preferred Formulary, a list of approved and covered drugs that applies to 25 million Americans with its pharmacy insurance. 

"This is unprecedented," Miller said, explaining that specialty drugs of this type typically are priced right next to each other. 

Express Scripts declined to say how much it would pay for the AbbVie drug, which it will sell only through its by-mail Accredo specialty pharmacy. It lists for $83,319 for a 12-week treatment and is also indicated for a 24-week treatment for some patients. Drug makers typically discount drugs in the United States by 10 to 20 percent. 

Miller said that the AbbVie price was narrowing the gap towards the lower prices that Western European countries have negotiated for their citizens for Sovaldi. They run from $51,373 in France to $66,000 in Germany. 

The AbbVie regimen consists of four different anti-viral drugs to be taken as three pills in the morning and one in the evening. The U.S. Food and Drug Administration approved the regimen for patients with genotype 1 form of the virus, the most common type of hepatitis C and the most difficult to treat. 

Express Scripts said that starting Jan. 1, 2015, it would only pay for the AbbVie drug for patients who have genotype 1. Express Scripts will no longer cover Harvoni, a one-pill treatment for patients with genotype 1 that costs $94,500 for a 12-week course. 

It will cover Sovaldi in cases where patients have other types of the disease. 

Express Scripts said patients with both early and late forms of the disease will also be reimbursed for the AbbVie drug. 



-- Edited by pamelajean on Monday 22nd of December 2014 02:49:10 PM

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