Will your private health insurance cover Sovaldi? (Part 2)
Back in July, we brought you Part I of a series of posts about how to afford Sovaldi (sofosbuvir), the new Hepatitis C (Hep C) cure in the form of a $1,000 pill — $84,000 for the standard 12-week treatment. We focused on consumers paying for Sovaldi in cash. It wasn’t pretty.
Thankfully, most Americans who are taking and will take Sovaldi are covered by health insurance. And if Sovaldi is on the drug list of your health insurance plan then the cost can be a co-pay of $75/month or sometimes $175/month, which is not too bad all things considered. However, as we know – health insurance policies don’t cover all medications, even ones that are far less expensive than Sovaldi. Not surprisingly, health insurance companies are resisting open coverage policies for Sovaldi. In fact, there’s a big battle brewing between Big Health and Big Pharma about who is to blame for problems with affordable access to Sovaldi and other specialty meds – but that’s for another day.
The short answer to the blog title question is – Sovaldi coverage depends on multiple and often technical variables, such as, your age, current health, efficacy of other treatments, intolerance to treatments that are recommended to be taken with Sovaldi, Hep C genotype, history of drug abuse, and more! Herein I do my best to shed some light on what’s up. I believe you’ll find below that most privately insured Americans with Hep C are not guaranteed access to Sovaldi. (more…)gentotype, prior authorization, sofosbuvir, Sovaldi