Insurers balk at paying for hepatitis c drugs – the boston globe

In addition to Tufts, Harvard Pilgrim Health Care, Neighborhood Health Plan, Boston Medical Center HealthNet Plan, Health New England, and Fallon Health will pay for the new class of hepatitis C medications only for patients whose livers are already severely damaged.

The plans vary in their approach to patients’ use of drugs and alcohol. Direct insurance login Some require six or 12 months of abstinence; others only mandate ongoing counseling for addiction. Open and direct car insurance derry All require that the prescribing physician be a specialist.


These practices are not unique to Massachusetts. Phone number for hastings direct car insurance Last week, New York’s attorney general sued an insurer for allegedly refusing to cover hepatitis C drugs unless the patient has advanced liver disease.

Eric Linzer, spokesman for the Massachusetts Association of Health Plans, said the hepatitis C drugs are “so excessively priced that it does create significant challenges.” To add to the challenge, he said, when the first of the new class of drugs, Sovaldi, came on the market in late 2013, clinical guidelines had not been developed and since then have kept changing. Professionals direct insurance company grand rapids Insurers’ advisory committees meet quarterly to update policies based on new evidence and guidelines, he said.

Blue Cross Blue Shield of Massachusetts, whose 2.8 million members represent roughly half the state’s commercial market, has a more liberal policy than the smaller plans: It pays for hepatitis C treatment regardless of whether a patient’s liver is damaged or whether the patient is using drugs or alcohol.

“These drugs, although very expensive, are really revolutionary in their ability to cure the virus,” said Dr. Direct insurance company phone number Tony Dodek, Blue Cross’ vice president for medical quality and strategy. Auto direct insurance contact number But the added costs “show up in premiums,” he said.

Blue Cross, Dodek added, is unlikely to see the savings from illness avoided: Most patients it paid to treat will be on Medicare by the time they would have developed cirrhosis or cancer.

Getting approval for the coverage is often only the first hurdle. Auto direct insurance reviews Many health plans have high deductibles requiring a hefty out-of-pocket payment or co-pays that can be prohibitive.

The list prices for the hepatitis C antivirals range from $54,600 to $94,500 for a three-month course of treatment. Canadian direct auto insurance calgary But insurers negotiate discounts — and don’t reveal what price they arrived at. Canadian direct insurance vs icbc Dodek said Blue Cross, because of its size, is able to negotiate bigger discounts.

So far, Blue Cross has paid for the new hepatitis C drugs for about 1,400 people. Call direct line car insurance from abroad In the state’s Medicaid program, more than three times as many people have received the treatment.

Getting approval for the coverage is often only the first hurdle. Canadian direct insurance claims Many health plans have high deductibles requiring a hefty out-of-pocket payment or co-pays that can be prohibitive.

The Center for Health Law and Policy Innovation of Harvard Law School analyzed plans sold on the Massachusetts Health Connector, the state agency for people who buy insurance on their own, most of whom have moderate to low incomes. Flux direct car insurance number The center found that in nearly half the plans, patients had to pay a higher percentage of the cost for hepatitis C drugs than for most other drugs. Canadian direct auto insurance reviews Some insurers require patients to pay half the cost.

People who are on Medicare can obtain the drugs if they purchase a Part D prescription-drug policy, but those policies typically require deductibles, copayments, and sometimes prior authorization — all of which can limit access.

For the majority of people infected with hepatitis C, the virus lingers in the liver for decades. Direct auto insurance call center About 5 to 20 percent of those infected eventually develop cirrhosis, and 1 to 5 percent die from liver cancer or cirrhosis. Canadian direct insurance contact But these illnesses occur 30 years or more after infection.

The virus’s slow progress has provided a rationale for some of the restrictions: Insurers and Medicaid plans with limited resources say they need to prioritize the sickest people, because the others are not at immediate risk of severe illness.

That is cold comfort for Tortelli, who became infected through a blood transfusion during heart surgery in the years before a screening test existed for donated blood. Call direct line car insurance (Hepatitis C is spread through blood, most commonly when intravenous drug users share needles.)

When he learned of his infection, Tortelli considered the treatment then available, interferon, and decided against it. What is direct insurance That drug would have made him feel like he had the flu for a year, and in the end, he would have only a 40 percent to 45 percent chance of a cure. Open and direct car insurance newtownards His doctor, Nezam H. Direct insurance hours Afdhal, said a heart condition also made Tortelli a poor candidate for interferon.

Tortelli was thrilled when more effective drugs, requiring only eight to 12 weeks of treatment with minimal side effects, came on the market. Phone number for direct general insurance Afdhal, chief of hepatology and director of the Liver Center at Beth Israel Deaconess Medical Center, said Tortelli was a candidate for Harvoni, a drug approved in 2014.

But Tufts Health Plan refused to cover it because Tortelli’s liver wasn’t damaged enough. Direct line car insurance number Now, Tortelli has applied to get Zepatier, a drug made by Merck and approved in January. Auto direct home insurance contact He awaits an answer.

“It drives me nuts,” said Afdhal, who led the clinical trial of Harvoni and holds a paid position on the scientific advisory board of its manufacturer, Gilead Sciences (as well as that of Merck and other companies involved with liver diseases). Direct line car insurance contact number uk “It’s very frustrating to have been involved in the development of such treatments and then to have trouble getting access to those treatments for our patients.”

Even patients with minimal liver damage often have other health problems resulting from the chronic inflammation the virus causes, Afdhal said. Call hastings direct car insurance Tortelli, for example, suffers from joint pain, fatigue, and difficulty making decisions.

“It makes me feel angry at the insurance companies,” Tortelli said. Canadian direct insurance ontario “I’ve worked all my life, had health insurance all my life. Direct car insurance phone number I’ve been waiting for this cure to come along — and now I can’t get it.”

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