Cat your going too give your self a heart attack. By the time you start tx things will be worked out. I'm pretty sure in the near furture ES will carry sovaldi. I'm sure all the big pharmacy's are thinking the same thing about price just not as out spoken as ES. They want 1k will settle for 500.

dragon - others always think I'm all stressed out and going to give myself a heart attack, but not to worry, that won't happen. It's just how I come across; how I write. A flair for the dramatic - former English teacher - I'm not as wigged out as I seem from reading my posts.

I express my opinions with a lot of VA-VOOM ! :)

p.s. dragon "by the time I start tx" was supposed to be by the end of next month. That WAS the plan. I'd say that's not going to happen. But hey, what can I do about it? Nuttin.

Cat, in my model, 50% of the patients (or their insurance company) pays an average of 50%. You should find out about the Gilead support program. Here's what the article said.

The SupportPath (http://www.mysupportpath.com) patient assistance program (PAP), with a $100,000 maximum income allowance for a household of three and 500% of the federal poverty level (FPL) eligibility criteria for larger households.

* The SupportPath Sovaldi co-pay coupon program will provide co-pay assistance for eligible patients with private insurance, including ACA Marketplace exchange patients, who need assistance paying for out-of-pocket medication costs. Most patients will pay no more than $5 per co-pay. Co-pay assistance of up to 20% ($16,000) of the WAC price for Sovaldi can also be applied toward prescription deductibles and co-insurance obligations.
* Gilead has made a contribution to the Patient Access Network (PAN) for co-pay assistance for Medicare Part D clients.
* Gilead has initiated an emergency Sovaldi supply program for patients that may lose their prescriptions.
* Gilead has agreed to ensure access to its PAP and co-pay assistance programs for AIDS Drug Assistance Program (ADAP) patients who are co-infected with HIV, even in states with ADAP programs that will not include Sovaldi on their formularies.

[Giving assistance to folks with $100K income or 5X the poverty level is pretty generous and most folks should qualify! Here's Fed Poverty level guidelines: http://www.familiesusa.org/resources/tools-for-advocates/guides/federal-poverty-guidelines.html 5X for family of 2 is $77,550/year...]

Don't fret - talk to Gilead and ask for help!

HC

Great post hepcat...so happy to see you posting again. DS wasn't the same without your insight, intelligence. knowledge and humor.

I, too, am extremely grateful for Gilead (and BMS) for clearing the virus. But that doesn't change the fact that I abhor how certain things work with corporate America.

Stick around my lovely...everyone here will be benefit. xoxoxo

So the Gilead confessions are somewhat new, as we only read about the co-payment assistance for up to 20% or the $16.000 . Al the other data is the first time we / i heard of , read it anywhere. i guess the pressure was fairly great because of their price created an upheaval. Great, informative reply nonetheless. now this is something to work with.

hepcat - this is why I will not qualify (I filled out these sections on their website). It has nothing to do with income in my case, it has everything to do with my having TriCare and not willing to give up my prescription benefits with them (for everything ELSE I need).

Are the patient's prescriptions paid for in part or in full by any state or federally funded program, including but not limited to Medicare or Medicaid, Medigap, VA, DOD, or TRICARE? YES
yes -- The patient is not eligible at this time. If you have questions, please call 1-855-7-MYPATH (1-855-769-7284).

If the patient begins receiving prescription benefits from such state or federally funded programs at any time, he or she will no longer be eligible to use the co-pay coupon. Does the patient acknowledge his or her agreement with this statement? NO
No The patient is not eligible at this time. If you have questions, please call 1-855-7-MYPATH (1-855-769-7284).

Hi Cat,

Did you call their 800 number? Maybe they can talk to Express Scripts or Tricare for you. It's worth a shot.

If my insurance company is being a shithead, I go to the Insurance Commission in my state. I've done that once, 30 years ago when I lived in Texas. Every state has an Insurance Commission. They license the Insurance Companies & if they don't do what the Commission says, well it's bye-bye license and then they make no $$.

But who the hell do you complain to for Medicare-related products? I don't think I'll like having to get on that because, well, it's the gov't. I don't trust those guys!

Good luck to you Cat and I now understand and empathize with your situation... so sorry.

HC

HC - I see my hepatologist a month from today. I'll discuss this with him - see what he has to say, what he suggests - HE is the one who will need to plead my case with any of these "people" - Gilead, Abbvie, TriCare, Express Scripts - a case that I can't wait. Just my talking to them wouldn't really hold much weight, ya know? But an "esteemed" hepatologist's opinion backed with his copies of my labs, etc. - now that talks.

My state insurance commission isn't going to have any oversight with my FEDERAL insurance, actually a "healthcare program." My TriCare coverage comes from my husband's retired status in the U.S. Army - federal all the way.

I have a great hepatolgist and he's savvy with this sort of stuff - I'm sure this latest crunch by Express Scripts is a bit of a mountain for him to climb, but... he can and will fight this battle for me. I have another great hepatologist in my back pocket too should I need him - he will be seeing patients in Vegas in a few months. He's been "on leave" since August - and expanded his vision and his services to us "heppers" - so I can see him again (as I have a few times before) in Vegas pretty soon.

But thanks for your ideas.

I was thinking Gilead could talk to Tricare, along with your doc. If they're denying you, they're denying others.

Gilead might help alleviate their concerns. They'll be motivated to help out.

If I were unable to treat, I'd probably develop a whole list of heath consequences which would be costly Tricare needs to understand it's cheaper for them to remove the root cause - eradicating your HCV!

HC

I use tri care as my secondary ins they usually pay what my primary doesn't. My primary doesn't use ES. Should be interesting to see how this thing plays out next month.