Express Scripts is not going to pay for Sovaldi - at least not now and probably not in the near future until they either get pressured enough (by whom I don't know) or, like they stated, OTHER tx's come out, like Abbive (which is not likely for another year) so they can compare prices.

Other PBM's (pharmacy benefits managers) apparently are on board with paying for it - but the only way to find out for sure is calling and asking your PBM. Express Scripts is mine. We're not talking insurance companies, exactly, we are talking about whomever your medical insurance company contracts with to provide prescription drugs for patients - your meds are "approved" by them, the PBM, then the pharmacy fills them.

Express Scripts pays for very expensive cancer treatment - but they chose THIS to draw a line in the sand. I am shocked and angry and ... just a wee bit worried since I'm late stage and cannot tolerate interferon so am left with - NO TREATMENT unless I pay for it out of pocket - yeah, right.

This was the first thread about it (it's on page 2 here):

http://www.dailystrength.org/c/Hepatitis_C/forum/17837819-express-scripts-wages-war

And we've discussed it some in other threads. I don't even want to discuss it anymore because ... it makes me quite angry. And scared. I'm seeing my hepatologist in a month and will report back here on what he tells me about this nightmare situation for those of us who have Express Scripts as our PBMs. We were all set to request approval from ES for my off-label tx with Sovaldi (sofosbuvir) and Olysio (Simeprevir). Ain't gonna happen, and my liver is just gonna get sicker.

Identical situation. My liver doc was going to use me as "guinea pig" to see if he could insurance approval of off label Sofosbuvir and Semeprivir. But my prescription plan is Express Scripts which won't even pay for ONE, much less TWO! I see my doc again Jan 20.

Very upsetting.... I have never had any problem with any other medication coverage EVER! And yes, if we had cancer they'd pay for whatever we needed, wouldn't they? I guess they want us to wait until we do have cancer?

The really stupid thing is this.....yes, the drugs are expensive, but less so than a liver transplant. But that's not the concern of the drug ins co.

Express Scripts should be fighting with Gilead, not punishing us.

Read it and weep:

"90 percent of privately insured patients in the United States receive coverage for Viagra"
http://www.nytimes.com/2013/05/07/business/pfizer-begins-selling-viagra-online.html?_r=0

PLUS those without insurance coverage can chop online for the stuff and there are many generic versions.

MORE:

"Since the 1980s, 15 statesArkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginiahave passed laws that require insurers to either cover or offer coverage for infertility diagnosis and treatment. Thirteen states have laws that require insurance companies to cover infertility treatment. Louisiana and New York prohibit the exclusion of coverage for a medical condition otherwise covered solely because the condition results in infertility. Two statesCalifornia and Texashave laws that require insurance companies to offer coverage for infertility treatment. While most states with laws requiring insurance companies to offer or provide coverage for infertility treatment include coverage for in vitro fertilization, California, Louisiana, and New York have laws that specifically exclude coverage for the procedure.

"Such procedures can be quite expensive according to RESOLVE on average each cycle of IVF costs $8,158 plus $3,000 to $5,000 for medicationsand debate exists about whether insurance plans should cover them. Studies have shown that assisted reproductive technologies have contributed to an increase in multiple births, which have a higher rate of prematurity than single births. In 2007, 8.2 percent of all newborns were low birthweight (less than 5.5 pounds), the highest percentage since the early 1970s. Preterm births cost society at least $26 billion per year."
http://www.ncsl.org/research/health/insurance-coverage-for-infertility-laws.aspx

*** As if having a baby -- or a boner -- was a matter of life and death! ***

I can't find it but I was told in California, they are pushing to have SURROGACY covered by insurance!

How disgusting re. Viagra. I'm getting madder than a hornet about this nightmare, RASS.

Indeed - "*** As if having a baby -- or a boner -- was a matter of life and death! ***"

I wonder if illegal aliens will be able to get Sovaldi? Free? I shouldn't say that, but... I feel like we are being discriminated against because WE ARE.

Thanks for explaining. I wonder how many insurance co's use ExpressScripts. I"m in the process of needing to choose an Obamacare plan -- I hope I can find one that uses something else.
BTW, maybe a class action lawsuit would change their mind? It's got to be illegal.

A class action lawsuit takes YEARS. I don't have time to wait for that to MAYBE resolve this in my favor. And sure, if I get into a lawsuit, would Express Scripts EVER cover me again? Can't risk it.

Express Scripts is a HUGE PBM - so you need to do your homework when choosing your obamacare providers. Basically, you will have to call the PBMs of each insurance company available and see if they cover Sovaldi. Gonna take some time and effort.

Here's one way for us to all get it: Rob a bank. GET ARRESTED and go to PRISON.

Prisoners get better medical care than any of us do! I betcha our tax dollars are paying for THEM to get Sovald ! ! !

We are even paying for prisoners to have sex reassignment surgery!! Again, as if that's life or death!!

GRRRRR!!!!

How about some letters to the editors? Op Eds etc???

It looks like there will be high costs for everyone with or without insurance. I'm waiting to find out how much my treatment will be and if my insurance will even cover some of it. I have an HMO but they are starting to charge large co-pays for lots of things that were once covered (like $50 for a catscan, $10 to draw my blood, etc.). They're nickel and diming folks to death. And this is on top of receiving premiums of over $900 a month (some from employer, some from us). If someone can wait for treatment, the price will likely come down, but that could take a few years.

I think the main problem is the stigma. If you read a mainstream article about HEP C they always add that HEP C is associated with IV drug use.

Here's a good example from a news story about HCV in Prisons:
"Hepatitis C is one of the most prevalent diseases in Californias prison system; its usually spread by sharing needles used for drugs and tattoos."

Nobody GAS about a bunch of druggies. Some people actually believe they deserve to die if they cannot afford the penance price. We need a better PR campaign for HCV.

You may very well have a point, thatwhich...

RASS - you're killin' me! But you're RIGHT.