Medicare Part D - Harvoni

somarco

GA Medicare Expert
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36,596
Atlanta
Appointment tomorrow AM with prospect going in Medicare and will be going on Harvoni very soon.

Daily pill at $1,000 per pill for 90 days.

Cost under D is $7,000 month 1 and he hit's the donut hole.

Covered by Part D but appears PAP's won't touch it if you have Part D, not even while in the donut hole.

Suggestions?
 
Appointment tomorrow AM with prospect going in Medicare and will be going on Harvoni very soon. Daily pill at $1,000 per pill for 90 days. Cost under D is $7,000 month 1 and he hit's the donut hole. Covered by Part D but appears PAP's won't touch it if you have Part D, not even while in the donut hole. Suggestions?

Some PAP's will cover a med if it isn't covered by that persons Part D plan. Can't say if Harvoni PAP works that way. If so, the prospect could enroll in a Part D plan that doesn't cover Harvoni. Of course, I'd recommend he find out he qualifies for the PAP prior to choosing this option.

By the way, what are you doing going on appointments?
 
Appointment tomorrow AM with prospect going in Medicare and will be going on Harvoni very soon.

Daily pill at $1,000 per pill for 90 days.

Cost under D is $7,000 month 1 and he hit's the donut hole.

Covered by Part D but appears PAP's won't touch it if you have Part D, not even while in the donut hole.

Suggestions?

Heres the dosing guidelines: http://www.rxlist.com/script/main/mobileart-rx.asp?drug=harvoni&monotype=rx-ids&monopage=3

Any chance he's currently on a group plan? That will cover it? First time treatment duration is 12 weeks. Looks like a one time treatment. Get it prescribed now. Even if he goes on Part B 6/1, you've got the 3 month window, even if he does COBRA. Get the 12 weeks done before he goes on Plan G/N/whatever and Part D. COBRA is probably going to be cheaper than the RX under Part D.

My two cents
 
Scott, the PAP's I looked at don't cover Harvoni if you have D and that includes while in the donut hole. Same for Gilead that manufactures Harvoni.

All the D's that popped up cover Harvoni. Pretty sure they have to per CMS directive. There are a few hoops to jump through for Mcare approval.

Can't see recommending he go without D just to get PAP and then have to wait until Oct to pick up D for 2016.

Never said I was going to see the guy, only said I have an appointment. Sometimes I make advance phone appointments instead of just calling during supper time and surprising them.

Jenny, I don't believe he is on a group plan now but will verify. Going to get more details tomorrow regarding current treatment regimen. Can't imagine he was just diagnosed and they are starting him out on Harvoni.

Haven't talked yet, just email correspondence.

COBRA is a good idea, assuming that is an option.
 
Scott, the PAP's I looked at don't cover Harvoni if you have D and that includes while in the donut hole. Same for Gilead that manufactures Harvoni.

All the D's that popped up cover Harvoni. Pretty sure they have to per CMS directive. There are a few hoops to jump through for Mcare approval.

Can't see recommending he go without D just to get PAP and then have to wait until Oct to pick up D for 2016.

Never said I was going to see the guy, only said I have an appointment. Sometimes I make advance phone appointments instead of just calling during supper time and surprising them.

Jenny, I don't believe he is on a group plan now but will verify. Going to get more details tomorrow regarding current treatment regimen. Can't imagine he was just diagnosed and they are starting him out on Harvoni.

Haven't talked yet, just email correspondence.

COBRA is a good idea, assuming that is an option.

Thought this was interesting
http://www.latimes.com/business/la-fi-anthem-blue-cross-harvoni-lawsuit-20150518-story.html
 
Appointment tomorrow AM with prospect going in Medicare and will be going on Harvoni very soon.

Daily pill at $1,000 per pill for 90 days.

Cost under D is $7,000 month 1 and he hit's the donut hole.

Covered by Part D but appears PAP's won't touch it if you have Part D, not even while in the donut hole.

Suggestions?





Wow this is the most expensive part d drug i never heard of! The cost of this drug to the insurance company is about 92,000.00 so 7,000.00 opp is actually not too bad and if he taking any other normal high cost brand name drug he will only pay 5% all year for those too since he will bust out of gap on first fill of harvoni.According to what I see the typical dosage is 84 pills filled once a year so if he has coverage now he may not need to use part d for another 12 months
 
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Wow this is the most expensive part d drug i never heard of! The cost of this drug to the insurance company is about 92,000.00 so 7,000.00 opp is actually not too bad and if he taking any other normal high cost brand name drug he will only pay 5% all year for those too since he will bust out of gap on first fill of harvoni.According to what I see the typical dosage is 84 pills filled once a year so if he has coverage now he may not need to use part d for another 12 months

I talked to a lady last month, she has Hepatitis C, and has been approved for the drug Sovaldi, which also costs $90,000. That's a lot of money.
 
Jenny, I saw that. CMS has strict guidelines on approval as a treatment protocol. Carriers usually follow what CMS says.

Harvoni is now FDA and Medicare approved.

Harvoni: What You Need to Know about the Newest Hepatitis C Treatment - Lucinda K. Porter, RN

Many expensive drugs are covered under Part B, but not this one.

What Are the Top 10 Most Expensive Medicare | Medicare News Group

Harvoni is tier 5

Medicaid placing limits on coverage
http://www.modernhealthcare.com/article/20141021/NEWS/310219962

Never been impressed with GoodRx but I know some people swear by them.
Harvoni Prices and Harvoni Coupons - GoodRx

Only $32k for a 28 day supply with a free coupon.

Such a deal
 
Jenny, I saw that. CMS has strict guidelines on approval as a treatment protocol. Carriers usually follow what CMS says.

Yes! My clients love it when I tell them the carrier is going to pay for what the FDA approves.

Only $32k for a 28 day supply with a free coupon.

Such a deal

I'm wondering why this one (and its twin) didn't get orphan drug status. How many people have Hep C?
 

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