July 20, 2015 — Gilead Sciences will not allow insured patients to enroll in its assistance program for Sovaldi and Harvoni, two drugs that can cure hepatitis C but are so expensive most people cannot get treatment.
Specifically, patients who have insurance but do not meet their insurance company’s coverage criteria will no longer be eligible for the assistance program.
The Wall Street Journal reports that Gilead is taking this step after finding that insurance companies have continued to restrict coverage for the drugs despite receiving “generous” discounts in recent months.
The payment-assistance program is supposed to help patients with high insurance co-pays or those whose insurers don’t fully cover Sovaldi and Harvoni. However, Gilead says some insurance companies abused the program:
“Our [program] criteria enabled continued restrictions by some payers by providing a generous route for them to deny access and refer patients they have chosen not to cover.”
About three million people in the United States have hepatitis C, mostly through transfusions and transplants before the blood supply was screened in the 1990s. The numbers could spike as more baby boomers get tested for the infection.
Sovaldi and Harvoni can cure hepatitis C in just three months and with far fewer side effects than other drugs. However, with a price-tag topping $84,000, almost no one can afford it out-of-pocket. For the rest, insurance companies have denied coverage unless patients develop end-stage liver fibrosis or cirrhosis (scarring).
The problem is that it can take years or even decades for hepatitis C to get that bad. In the meantime, the patient suffers from gradually declining health and other debilitating symptoms of their disease. They might also spread hepatitis C to healthy people.