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Hi, I got two letters from Express Scripts. One for Olysio and an identical letter for Sovaldi. Did you get these? I have already received the full twelve weeks supply so I don't think I will have a problem but I am not sure.
Both letters say: We're writing because you need to take action if you want the following medication to be covered under your plan.
Olysio, Sovaldi
,,,Epress Scripts...want you to know an about an important change. Beginning 4/15/2014 your plan's coverage of this medication will change, and Express Scripts will need to preview the prescription with your doctor before it can be filled and covered under your prescription benefit. During this review, your doctor can provide us with more detailed information on your prescription so we can make sure its use falls within your plan's rules. These rules are based on FDA-approved prescribing and safety information, clinical guidelines and uses that are considered reasonable, safe and effective.
If you're taking the above medication and want it to be covered by your plan, here's what you can do to help make sure your medication is reviewed:
1) Please ask your doctor to call Express Scripts at 800.4171764 to arrange a review.
2) Let your doctor know we're available Monday-Friday, from 8 am to 9 pm.
If you're doctor doesn't call and get approval, you'll be responsible for the full cost of the medication. So please have your doctor contact us on or after 4/15/2014.
Thank you for your assistance. If you're no longer taking the medication above or no longer eligible under this plan, please disregard this letter.
Both letters say: We're writing because you need to take action if you want the following medication to be covered under your plan.
Olysio, Sovaldi
,,,Epress Scripts...want you to know an about an important change. Beginning 4/15/2014 your plan's coverage of this medication will change, and Express Scripts will need to preview the prescription with your doctor before it can be filled and covered under your prescription benefit. During this review, your doctor can provide us with more detailed information on your prescription so we can make sure its use falls within your plan's rules. These rules are based on FDA-approved prescribing and safety information, clinical guidelines and uses that are considered reasonable, safe and effective.
If you're taking the above medication and want it to be covered by your plan, here's what you can do to help make sure your medication is reviewed:
1) Please ask your doctor to call Express Scripts at 800.4171764 to arrange a review.
2) Let your doctor know we're available Monday-Friday, from 8 am to 9 pm.
If you're doctor doesn't call and get approval, you'll be responsible for the full cost of the medication. So please have your doctor contact us on or after 4/15/2014.
Thank you for your assistance. If you're no longer taking the medication above or no longer eligible under this plan, please disregard this letter.
I HOPE there is not such a big problem when the Sovaldi/Ledipasvir "one pill wonder" comes out in the fall. It WILL be FDA approved, so insurance companies can't balk at that, as they can with off-label Sovaldi/Olysio, BUT the doc said that the issue is the cost. The insurance companies are being bombarded all of a sudden with orders for Sovaldi, and they simply don't want to pay for it. Gilead has GOT to take the price down! If they don't, many even with insurance will be denied. NOT RIGHT! Just because the "cure" was found, and of course millions want it, they say "no, it's too expensive?" Outrageous.
Whew! Thank you for this post. I won't freak if I get one of those letters. My insurance has paid for all 12 weeks, so I will toss it.
So when used with the FDA approved tx for Geno 1's (which means Interferon and Riba), yes Sovaldi is FAR superior to Oly. Sovaldi + Riba is FDA approved too, but it's a longer tx and has the poison Riba.
When I get my last shipment of Sova/Oly tomorrow I will be shouting, "HALLELUJAH" ~~~!!!
It is ABSURD for them to request approval for RXs already filled!!! Mine have been all filled and paid for my my insurance any my co-pays ....
We all get one month at a time but they know it's a 3 mo treatment. How can they approve it and then stop approving midstream?? I see that as basically as fraud and EXTORTION - forcing patients to have to pay cash for the remainder or stop midstream??? This is INSANE!! I hope someone sues them! GRRRRRR!
Marilyn - TWO MONTHS!?? That must be a record! So sorry. Sure hope this insane pricing and insurance crap does not occur with Ledaspivir.
I posted their contact info, but you can simply google them. Phone calls to legislators are tracked and they do have an effect! I will be calling both again and telling them about these letters. It may very well be illegal for gilead to stop payment for anyone who has already been approved and/or started treatment.