Harvoni Copay Costs!!

[art1951]

I have been on Harvoni for 3 weeks and just went to the pharmacy for my next months prescription and got a wake up call.  When I first went to them they mentioned that they were managing the relationship with Gilead and had the $5 coupon and it would cost me $5 copy each of the 3 months.  On this trip they told me that the Gilead coupon was used up and it would cost me $3,800 out of pocket for this month and $14,500 for the last month.  My insurance has a 30% copay for prescriptions.  The coupon covers a maximum of $23,500. 
I tried mysupportpath but they confirmed that the coupon has been used and they recommended I try needymeds.org.  Unfortunately they only help those who are below the poverty level which I am not.
Any advise?  I can try and get a loan but I don't have $18,529 under my mattress.

Thanks
-Art 

[Bucky]

I have been on Harvoni for 3 weeks and just went to the pharmacy for my next months prescription and got a wake up call.  When I first went to them they mentioned that they were managing the relationship with Gilead and had the $5 coupon and it would cost me $5 copy each of the 3 months.  On this trip they told me that the Gilead coupon was used up and it would cost me $3,800 out of pocket for this month and $14,500 for the last month.  My insurance has a 30% copay for prescriptions.  The coupon covers a maximum of $23,500. 
I tried mysupportpath but they confirmed that the coupon has been used and they recommended I try needymeds.org.  Unfortunately they only help those who are below the poverty level which I am not.
Any advise?  I can try and get a loan but I don't have $18,529 under my mattress.

Thanks
-Art

Hi Art,
Something I don't understand, from their wed site: Co-pay Coupon Terms and Conditions

    "The HARVONI co-pay coupon program will cover the out-of-pocket costs of your HARVONI prescriptions after you pay the first $5 per prescription fill, up to a maximum of 25% of the catalog price of a 12-week regimen of HARVONI. The offer is valid for 6 months from the time of first redemption". 
 So what I am understanding is that since you have a 30% copay then you went over the 25% maximum the first month.
If I may ask, who is your insurance carrier?
Bucky

[Bucky]

Art,
I looked at your old posts and see that you have BCBS so I am guessing that Express Scripts handles your meds. Is your insurance through your work?
Bucky

[art1951]

Bucky,
I have BCBS of Oklahoma through work.  They directed me to Prime Specialty Pharmacy. 
My doctor originally asked me to use American Specialty Pharmacy and BCBS sent me a letter that there would be a 20% penalty for going outside of their network.  They also stated that they had not heard of Harvoni and that I should go ahead and get the second round filled from American Specialty.  American Specialty mentioned that my copay is $14,655 each time and that the Gilead coupon had covered the first batch and all but $3,869 of the second batch and the coupon was then used up and I would have to pay the full $14,655 for the December batch.

I have called Prime Specialty Pharmacy again and they are checking on Harvoni and will get back to me on Monday.

Thanks,
Art

[marv777]

https://www.panfoundation.org/    Hey Art, try this place. It is based on income if you qualify and they helped me out. My ins. covered most of the bill but my co-pay was 1037.00 for my first 28 pills and 6.50 for second bottle and since third bottle is after the first of the year the last co-pay is 1037.00 again. I was on the phone with them and ten minutes later they gave me a grant for 10000.00 and said if I needed more to call them back. So not sure if it will help but they sure made my day. Mark

[art1951]

Thanks,  I tried them but do not qualify because of income.

Art

[Bucky]

https://www.panfoundation.org/    Hey Art, try this place. It is based on income if you qualify and they helped me out. My ins. covered most of the bill but my co-pay was 1037.00 for my first 28 pills and 6.50 for second bottle and since third bottle is after the first of the year the last co-pay is 1037.00 again. I was on the phone with them and ten minutes later they gave me a grant for 10000.00 and said if I needed more to call them back. So not sure if it will help but they sure made my day. Mark

Hello Marv,
Who is your insurance carrier?
Bucky

[marv777]

Hey Bucky, my part d drug plan is through United health care.  Gastro sent in the scrip and four days later he called and said i was approved.

[matradee124]

keystone 65 hmo rejected me for harvoni after I appealed they paid for s/o medication thank GOD