Author Topic: Express Scripts to cover AbbVie hepatitis C drug, drops Gilead treatment (Read 32904 times)

Lynn K · « **on:** December 22, 2014, 12:23:56 am »

http://www.reuters.com/article/2014/12/22/express-scripts-abbvie-hepatitisc-idUSL1N0U50M120141222

oh no.....

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.

sunrise · « **Reply #1 on:** December 22, 2014, 08:21:25 am »

Hi Lynn K
Oh no is right! You would think that anybody that had this type of insurance would leave, run from them. just for the fact if anything that they will not pay for medication that you need when you're sick? You would think that's what you're paying for. Unbelievable

donk · « **Reply #2 on:** December 22, 2014, 09:30:05 am »

I saw the interview with express scripts chief med officer on squawk box this morning. I am approved for 12 weeks Harvoni but they won't arrange shipment till 1/2/15. Even though I have the same insurance in 2014 they can't even tell me my co-pay till 2015. I don't have express scripts. Hope they don't change my meds to abbvie.

JillLynn · « **Reply #3 on:** December 22, 2014, 09:33:17 am »

Donk. I hope not too. You are sooooo close! Keep us posted.

BattleTheBeast · « **Reply #4 on:** December 22, 2014, 10:29:18 am »

I just got off the phone with Express Scripts again because the end date of my approval doesn't match the end date of my prescription. The person I spoke with who is a patient advocate told me they aren't approving for more than 12 weeks of Harvoni unless they meet a ton of prereq's and he said since my approval is through 3/5 he wants to wait until I get at least 12 weeks worth in my before ruffling feathers on my before pushing for the 24 weeks prescribed. So in early February before my approval expires he will help me deal with the red tape to get my additional 12 weeks.

It's amazing because I am F4 with a starting VL of over 8.4 million and they are saying they only approve in 12 week increments. I did read the UHC Guide and everything is about 8 or 12 weeks.

http://tinyurl.com/lxj8nr4

I will sit back and wait with my advocate and continue to push through, for now I need to relax and focus on the 10 weeks I know are headed my way.

Peace and hugs to all!

Mel

badbradley · « **Reply #5 on:** December 22, 2014, 12:19:37 pm »

Mel Two things occurred to me,
Sovaldi being the Kicker in the two treatment regimens, would 9 wks. of S/O + 15 wks. of Harvoni be near as effective as 24 wks. on Harvoni?
Then this, Are there any statistics on treating longer than 24 wks. on Sovaldi?
24 wks. Harvoni + 9 wks. S/O = 33 wks. of Sovaldi in your system.
Concerned Brad

Lynn K · « **Reply #6 on:** December 22, 2014, 12:22:43 pm »

I just got a call from Express Scripts for my refill bottle number 3 will be here on January 5th. I metioned to the woman on the phone about the news about express scripts and Harvoni she had no idea what I was talking about

brilliant

BattleTheBeast · « **Reply #7 on:** December 22, 2014, 02:05:09 pm »

Brad,

I hear you and have the same concerns. Honestly I think it would be great if I could get 16 weeks of Harvoni to go with the 8 weeks completed of S/O; then I will be at 24 weeks of Sovaldi

None of us know the long term of any of these medications yet. We may be meeting again in 3 years discussing that.

I am not overly concerned honestly at this point I am just grateful to get what I am getting and can only hope for the best, like all of us are doing.

Mel

DesertGuy · « **Reply #8 on:** December 22, 2014, 03:41:35 pm »

Just my two cents---sure xpress scripts says it's about money--they handled me with no problems--no complaints, but it is just my nature to question---do you think it could be because of the effectiveness of sovaldi after they approved it? Not even using it for a year and switching to different drug?--Makes me wonder about something so short lived on their shelves.

BattleTheBeast · « **Reply #9 on:** December 22, 2014, 03:49:18 pm »

Quote from: DesertGuy on December 22, 2014, 03:41:35 pm

Just my two cents---sure xpress scripts says it's about money--they handled me with no problems--no complaints, but it is just my nature to question---do you think it could be because of the effectiveness of sovaldi after they approved it? Not even using it for a year and switching to different drug?--Makes me wonder about something so short lived on their shelves.

Well Sovaldi is in Harvoni which has had amazing results so that may blow a slight hole in your thinking....

M

Lynn K · « **Reply #10 on:** December 22, 2014, 04:27:53 pm »

They a pulling Harvoni too I looked up stats for a patient like me cirrhosis null responder.

harvoni for 24 weeks 99% in trial

AbbVie combo, 6 pills (combo plus 2 riba), two dosing times a day, more side effects, cannot be used by prior protease inhibitor failures. For me 24 weeks 94% in trials.

It's all about the money. They said oh now we can treat everyone even the less sick. The reason the less sick were not being treated is because express scripts denied their requests for Harvoni.

Merry Christmas from Express Scripts

rainbowray · « **Reply #11 on:** December 22, 2014, 04:35:42 pm »

Well, After 24 weeks of Sovaldi/Ribavirin Desertguy has a right to question things.
I just did the same combo and it can screw up anyone's brain fog.
As for me, if sol/riba does fail, Abbvie is the choice, for Gen 1B =100%. But am I suppose to believe it?....
Sorry if I sound sarcastic, no harm intended to anyone. I'm still recovering from this dammed ribavirin.

Lynn K · « **Reply #12 on:** December 22, 2014, 04:46:17 pm »

Sure rainbow we all question

I too question after 3 null response treatments with interferon based treatment of 24 weeks each and 12 weeks of Sovaldo Olysio relapse and cirrhosis.

It does look like they will let us already on treatment continue I sure hope so I am afraid I am running out of options again if this doesn't work

rainbowray · « **Reply #13 on:** December 22, 2014, 05:02:50 pm »

But your to legit to quit.
New treatments are still on the way too.

JillLynn · « **Reply #14 on:** December 22, 2014, 05:04:08 pm »

Lynn K.......youre' on harvoni now right? For 24 weeks?
I'm going to be praying so hard THIS IS IT for you! And that you get to stay on it for 24 weeks!

I'm so rooting for you....you are one helluva warrior sister!!

Jill

JillLynn · « **Reply #15 on:** December 22, 2014, 05:05:07 pm »

right on Rainbow!

DesertGuy · « **Reply #16 on:** December 22, 2014, 05:11:02 pm »

Lynn--keep us posted ,please
Rainbow--I'm one week off the pills and not much recovery happening here--you??

Lynn K · « **Reply #17 on:** December 22, 2014, 06:58:12 pm »

Hi JillLynn

Yes 5 weeks of treatment completed today. I was initially approved for 12 weeks hoping express scripts carries me through to 24 weeks. The bottles say 6 refills total.

I am just scared based on the news report kinda running out of time and options.

rainbowray · « **Reply #18 on:** December 22, 2014, 07:19:07 pm »

Desertguy,
I'm almost thru with the itching, kinda over tired at the end of the day. My brain is on a low key motivation level. I know it is the effects of the rib. I still go to work and do what I have to, but really don't have the attitude to do a good job. It is the rib that takes your inspiration away at times. But I am getting spurts of energy here and there, and they say that is the beginning of recovery. My stools are still a brown color which is a sign the biribulim is still at ok level. Pale and then would be cause to worry. Remember I weened a little earlier than you too.

Rubye · « **Reply #19 on:** December 22, 2014, 08:34:23 pm »

Express Scripts has been saying for awhile they were going to do this but I don't think they could legally until AbbVie came out. I think if you've already started with Harvoni they will allow you to continue. Something to do with Continuity of Care. Plus, you could probably sue the heck out of them.

Actually, they would really just as soon you leave them because they don't want to have to pay out for Hep C patients. Express Scripts, being the largest drug plan for Medicare, has a lot of clout and have encouraged other drug plans to do the same. This is probably why Abbvie went with such a high price for the Viekira Pak. It gives them room to negotiate lower prices with the drug plans. I have Express Scripts myself and my payments went up starting January. Personally, Kaiser looks better every day.

badbradley · « **Reply #20 on:** December 22, 2014, 08:35:14 pm »

Quote from: BattleTheBeast on December 22, 2014, 02:05:09 pm

I am not overly concerned honestly at this point I am just grateful to get what I am getting and can only hope for the best, like all of us are doing.

Mel,
After todays "Special" Report, I Am feeling grateful as well for having the good fortune to treat with Sovaldi/Olysio. I would sure like to see you at least get an additional 4wk supply of Harvoni. I think it's a reasonable request. Good that you're not stressing at this point.
8 wks. S/O (got it) sorry! Got your back Mel Brad

sunrise · « **Reply #21 on:** December 22, 2014, 09:20:50 pm »

Hi warriors
First night without meds. Brad you are so right. I feel like im mossing something. I wish I didn't have this fear hanging over me of relapsing. I think hearing all this about big companies withholding treatment does a # on me. I pray for UD not just for me but for all the warriors here fighting this battle beside me. Thanks for letting me vent. At least I got gift shopping done today for my son and his girl. Im beat.
Hey Brad hpw did you feel the 1st day after no S/O?

badbradley · « **Reply #22 on:** December 22, 2014, 09:44:39 pm »

Sunrise,
Felt like someone took my pacifier away from me! The security of the meds kind of became a mental dependency for me. I kept thinking I should be doing something else now to take the place of meds. More jogging, more artichokes, something. But I soon chilled and started rolling with the changes!
I did have some mood issues that first week. Told a guy at work I liked him better with his old haircut. Hope you feel better and better and better.See Ya!
Brad

BattleTheBeast · « **Reply #23 on:** December 22, 2014, 09:48:32 pm »

Brad,

That is hysterical "I told a guy at work I liked him better with his old haircut"

I can't even imagine the look on his face when you said that! I seriously don't know how you guys continued to go into an office every day, I just couldn't do it and am so thankful I have been working for home!

Sunrise and Brad, I am glad you two can talk about being off the S/O, it's nice you can compare notes!

Mel

sunrise · « **Reply #24 on:** December 22, 2014, 09:51:02 pm »

Thats funny, I don't know if its on my head, I feel exhausted and a bit down. No reason to cept for this town sux. Other than that I am thanlful and content. I guess apprehensive is the word im looking for. Thanks Brad for staying and helping me with this along the way. You are 1 step ahead and are leading the way. Feel like we are in the woods trying to find our way out....

sunrise · « **Reply #25 on:** December 22, 2014, 09:56:36 pm »

So true Mel
Its nice to have a brother in this. What ever happened to Willie g? He should be getting his Vl Soon right? He was finished shortly after I started. He finished around Oct 9th if I recall. So that is coming up soon. Hope he is staying UD as well.

Lynn K · « **Reply #26 on:** December 22, 2014, 09:58:07 pm »

Hi Rubye

Sadly I have no choice than Express Scripts which is through my employer. Even with all the other plans they here at work all have Express Scripts is the prescription drug provider.

Although I work in a machine shop on second shift we too have bad hair days lol

badbradley · « **Reply #27 on:** December 22, 2014, 10:16:35 pm »

Sunrise Will be around for awhile yet. That's about right, feel like your lost in the woods sometimes. Funny you should mention that. I have been walking a newly found trail in the woods the past couple of weeks. It's pretty cool after a fresh snowfall. It's very serene! I highly recommend a good nature hike now and then.
What happened to willieg right? Did he get his butt kicked off the forum or what?
Merry Christmas willieg. Later Sunrise

Picnic · « **Reply #28 on:** December 22, 2014, 10:35:27 pm »

Gilliad dropped like a rock today. That's what happens when you get greedy. I wonder if they will now come down in price to compete? Anyone treated with the new drug. How are the side effects. I am on week 20 of S/O and am looking forward to my last 4 weeks!

Rubye · « **Reply #29 on:** December 22, 2014, 11:13:40 pm »

Sunrise - I think how you're feeling is perfectly normal. We all worry about reaching SVR. That's the whole point and aim of taking these drugs. I'm glad you are talking about how you feel. I will be there soon again. After thinking I was going to have to stop at 12 weeks my doctor was able to get me another 4 weeks. I think this thing with Express Scripts is why I didn't get another 12, but 4 is good and hopefully good enough. So, hang in there. Are you going to do a viral load at 4 weeks?

Lynn, I'm stuck with Express Scripts also unless I switch my Medicare plan. I mean I could change drug plans but Express Scripts is good in a lot of other ways. Fortunately for me I don't have to decide until I find out if I'm SVR12. They've paid for all my other scripts so far. I really think they will come through for you with the remaining refills since that's what they ok'd at the time of your approval.

sunrise · « **Reply #30 on:** December 22, 2014, 11:30:50 pm »

Thanks Rubye
I understand that it is normal, just have to stop what ifing myself.to.no end. Good luck with your treatment. Do you think 16 weeks will be enough? I don't get where administrators make decisions on health issues that your physcian had already decided for you. Crock of s***. Be well I'm headed to sleep. Long day at work tomorrow. Take care. Talk tomorrow....Blessings Sunrise

sunrise · « **Reply #31 on:** December 22, 2014, 11:38:28 pm »

Oh and yes 4, 12, and 24 vl tests. My doc is awsome. Just hope he had me in tx long enough. I think he is a good doc and weighed everything to make the 12 week decision. Goodnight warriors. Thank you for all your support. ...Sunrise

sunrise · « **Reply #32 on:** December 22, 2014, 11:41:07 pm »

Hey Picnic
Long time no see. 20 weeks im so proud of you. 4 to go! We will cheer you on. Have a Blessed Holiday. ... Sunrise

BattleTheBeast · « **Reply #33 on:** December 23, 2014, 01:49:45 am »

Quote from: Picnic on December 22, 2014, 10:35:27 pm

Gilliad dropped like a rock today. That's what happens when you get greedy. I wonder if they will now come down in price to compete? Anyone treated with the new drug. How are the side effects. I am on week 20 of S/O and am looking forward to my last 4 weeks!

Hi Larry,

Glad you came out of hiding, we needed a picnic around here lately! Sounds like you are doing ok. I am so glad you and Lynn got the 24 weeks; it sounds like it's going to be hard to come by soon. They have so many rules in place now you have to be almost decompensated to get 24. Hope this was your magic,

Mel

Lynn K · « **Reply #34 on:** December 23, 2014, 03:53:47 am »

Good thing I am almost decompensated then well maybe not but yes stuck with express scripts no other option no other choice. Well I guess I could quit my job and shop for a company that doesnt have express scripts but that doesn't seem practical somehow. So I am a captive customer.

Actually the approvel was for 12 weeks with a disclamer that approval subject to change if benefits change. So currently although the bottles reflect 6 bottles in total I am only pre-approved to early February at which time my doctor will have to ask for an extension of my approval.

But the good news is I got my week 4 labs back

ALT AST both 26
HCV RNA QT UNDETECTED

YAY!!!

sunrise · « **Reply #35 on:** December 23, 2014, 04:51:50 am »

So great to hear! Wonderful news. Hoping you have a great holiday, nothing better than to know you are UD!

sjking · « **Reply #36 on:** December 23, 2014, 07:33:33 am »

Hello Everyone, I just don't understand how Express Scripts can deny me Harvoni a few weeks ago because I'm not sick enough, and then turn around and offer another drug, one that they cut a deal to get and suddenly I will qualify for treatment (at least according to the newspaper reports)? This is immoral. Gilead is immoral for overpricing the drug. I just can't believe this behavior is legal.

While I'm thankful to be very healthy after 15 years and to finally have treatment options I'm really sick that I'll be forced to take a drug combo with more side effects because one guy in a suit cut a deal.

BattleTheBeast · « **Reply #37 on:** December 23, 2014, 08:17:56 am »

Quote from: Lynn K on December 23, 2014, 03:53:47 am

But the good news is I got my week 4 labs back

ALT AST both 26
HCV RNA QT UNDETECTED

YAY!!!

HOORAY!!!!!!!!!!!!!

sunrise · « **Reply #38 on:** December 23, 2014, 08:42:12 am »

Hi sjking
Im sick to hear that. Is there a way to appeal for the harvoni. Sometimes it takes a couple of tries to get it. I hope you can get it

JillLynn · « **Reply #39 on:** December 23, 2014, 10:27:15 am »

Lynn K...... awesome news! hip hip hooray!

I have good news too: My liver enzymes are almost in the normal range again. Not quite but soooooo much lower than before. The ZOLOFT was NOT my friend on this Harvoni treatment.

sjking...it really does suck the BS of these companies. Immoral like you said. wishing you the best for sure.

BadBrad: agree: nature walks are the way to go! even just stopping to listen to the leaves rustle brings me much comfort and peace and gratitude.

Sunrise: mornin' sista! Big Hug!

Jill

rainbowray · « **Reply #40 on:** December 23, 2014, 10:31:23 am »

Quote from: Lynn K on December 23, 2014, 03:53:47 am

But the good news is I got my week 4 labs back

ALT AST both 26
HCV RNA QT UNDETECTED

YAY!!!

NICE! Still to legit to quit.

sunrise · « **Reply #41 on:** December 23, 2014, 02:33:20 pm »

Hey Jill
Thats great news. Yippie yayaaa!!! Have a great day!

Picnic · « **Reply #42 on:** December 23, 2014, 05:04:10 pm »

Sunrise and Beastie Boy!
Glad to be back! Just received my last month of S/O today.i will be done 24 Jan 2015. I went through a funk when i hurt my right thigh at the gym. But I am back to the gym. We waited so long for these therapies and now they are duking it out. Good for us!! We finally found the chink in the dragons armor! Reminds me, I have to see the battle of the five armies!

sunrise · « **Reply #43 on:** December 23, 2014, 08:52:08 pm »

Hey Larry
Last set of bottles!!! Good luck and have a great holiday! Im 2 days out without meds. So far feeling ok. Best wishes Sunrise

Lynn K · « **Reply #44 on:** December 23, 2014, 08:52:30 pm »

Thanks all and congrats Jill!

badbradley · « **Reply #45 on:** December 23, 2014, 09:09:34 pm »

Jill - Great news about the stubborn enzymes. Happy for you and Happy Holidays!
Brad

Picnic · « **Reply #46 on:** December 23, 2014, 10:46:24 pm »

Sunrise do you miss the pills? Just kidding! Good luck with svr12 and 24.

sunrise · « **Reply #47 on:** December 24, 2014, 12:44:09 am »

Im missing something lol just my sanity. No I don't miss them just hope 12 weeks was enough

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Author Topic: Express Scripts to cover AbbVie hepatitis C drug, drops Gilead treatment (Read 32904 times)