As insurers limit access to hep C drugs, patients and doctors bristle

Doctors are finding themselves in tense situations as they try to prescribe new hepatitis C drugs to patients eager for a cure while health plans limit coverage to manage the costs of the medications.

Many health insurers have established prior-authorization criteria generally limiting access to the drugs to patients whose disease has progressed to at least Stage 3 fibrosis (just before the onset of liver cirrhosis).

The sticker prices of a course of treatment of the drugs range as high as $95,000. To mitigate the burden, major health insurers and pharmacy benefit management companies have entered special pricing agreements with Gilead for its new hepatitis C drugs Harvoni and Sovaldi or AbbVie for its competing drug Viekira Pak.

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Covered California weighs plan to reduce financial burden of expensive drugs for people with serious illnesses

Covered California, the state’s Obamacare health insurance exchange, could alter the way consumers pay for extremely expensive specialty drugs, but patient advocates say that medications for conditions such as rheumatoid arthritis and hepatitis C will still cost too much.

The exchange’s board of directors, which meets today, is scheduled to consider a proposal that would set a maximum monthly co-insurance cost of $200 to $500 per prescription.

Currently, consumers pay 10 percent to 30 percent of the drug costs, which can run into thousands of dollars and cause them to quickly reach their plan’s maximum annual out-of-pocket spending limits, which range from $2,250 to $6,250.

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