The assistance program was supposed to help patients with high insurance co-pays or those whose insurance didn’t fully cover Sovaldi and Harvoni. The drugs normally cost upwards of $84,000 for a standard 12-week course of treatment.
Because they are so expensive, many insurers won’t provide coverage unless the patient has end-stage fibrosis or cirrhosis of the liver.
The Wall Street Journal reports that Gilead provided “generous” discounts in recent months, but some insurers continued to restrict coverage. In response, Gilead will now limit enrollment in the assistance 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.”
The changes will put pressure on insurance companies to expand their coverage criteria. However, in the meantime, patients are still struggling to get access. Many have resorted to filing lawsuits against insurers for denying coverage unless they have end-stage fibrosis or cirrhosis of the liver. By that time, a patient may have suffered for years or spread the disease to people.
Sovaldi and Harvoni illustrate the problems associated with spiraling drug prices in the United States. In an effort to hold down prices, seven states have passed laws limiting out-of-pocket payments for patients with health insurance, according to the Washington Post.