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Express Scripts, AbbVie & Gilead

edited December 2014 in Fund Discussions
I know this site is dedicated to funds/etf's, but the captioned story affects many due to the high institutional ownership of biotech companies such as AbbVie and Gilead Sciences.

An uncle of mine was due to start using Gilead Sciences Harvoni regimen to cure his Hepatitis C beginning January 5, 2015. Because Express Scripts is his pharmacy benefit provider, my uncle now must change his prescription from the 1 pill a day Harvoni to AbbVie's drug cocktail to cure his Hep. C. This is what his doctor has told him. My uncle has yet to receive any reply from Express Scripts to his many inquiries!!!!!

I understand the high cost issue of using Gilead's Harvoni, although AbbVie's new Hep. C cocktail is still very costly. Nonetheless I (and my family) feel that my uncle's physician should be the person determining my uncle's medication, not the pharmacy benefit provider (Express Scripts). It's not fair to any human being that their medication is determined by a pharmacy benefit provider instead of a capable physician as we want only the best health care for my uncle.

I see that neither Gilead nor AbbVie's pps are up today, although Gilead really took a hit while Express Scripts is up on this news. I don't directly own any of these equities but do own them through some funds, and am simply angry at Express Scripts on my uncle's behalf.

Just needed to get this off of my chest.

~ PT


  • Thanks for sharing your story and sorry to hear about your uncle. It's very disappointing and sad that what is effectively sort of a "middle man" in the situation can determine what medicines can be provided. Gilead's medicine is expensive, but I'd guess a transplant is probably more expensive. Abbvie's medicine has more pills and more side effects.

    Best wishes for your uncle.

    Long GILD (added more today), not to mention a bunch of other pharma names/funds.
  • @PopTart, Do not let it end there. In many cases like this, your doctor can write a letter specifically asking for Harvoni along with medical reasons. There are always exceptions to the rule. Keep the pressure on and there is a good chance the insurance company will back off on their ruling.
  • My husband takes a on-patent name brand drug. The generic in-class alternative is a drug with dangerous metabolites and requires restricted diet. No plan should be able to substitute a generic (or cheaper) alternative when the active ingredient is a different chemical even if it is in-class. Express Scripts under my plan allowed for the safer drug.

    Because I am currently using Express Scripts (go to Caremark in a few days) I searched for Harvoni under my plan. It said that it was covered but might require a coverage review. It said that Harvoni was not the preferred drug but when I asked for a "generic alternative' it said there was none.

    My plan pays 90% of the cost of a name brand and has a limit on my cost. I've never seen the "coverage review" message but it might just be related to a new prescription of this sort going in a few days before the account moves to a competitor. I was unable to get it to show me the preferred alternatives.

    Here is the price Express Scripts gave me for a 30 day supply:
    Total cost: $30,423.75
    Your cost for this medication: $116.66
    What your plan pays for this medication*: $30,307.09
    Your plan pays approximately 100% of the cost for this medication.

    *The cost to your plan does not include any rebates or other incentives your plan may receive from your use of this medication. Express Scripts may retain or share some rebates with your plan. The cost your plan pays is an approximation and is subject to change.

    Coverage alert
    Coverage Review is required for Harvoni 90-400 Mg Tablet.
    For Participating Retail Pharmacy: This drug requires Coverage Review before you can receive it.
    For Home Delivery Pharmacy: This drug requires Coverage Review before you can receive it.
    More about coverage reviews:
    To receive coverage for this medication, you must obtain approval through a coverage review. If you do not do this, you may be responsible for the entire cost of the medication.

    Coverage notes
    For Harvoni 90-400 Mg Tablet when using your home delivery pharmacy benefit:Please wait ...
    This medication is covered under your plan; however, it is a non-preferred product.
    Please note that the coverage terms of this prescription benefit are subject to change.
  • FWIW, a relative took the injections about 5 years ago for Hep C. Super lucky to have very few side effects. All new oral drugs are much better. If patient is not suitable for Abbvie, doctor can request Harvoni. Best wishes for the uncle.
  • edited December 2014
    Thanks for the replies, yet the sudden bite from Express Scripts still hurts. My family doesn't at all like the sudden change in medication, especially when my uncle was already approved for Gilead's Harvoni regimen of one a day pills.

    Anna - as of this moment my uncle has yet to be able to get through to Express Scripts, so the info. that you provided is far more than Express Scripts has provided to my uncle. A non-preferred product and coverage terms are subject to change? Rotten Express Scripts certainly wasn't kidding, the prescription was changed in a heartbeat.

    A "middle man" should not have the authority to change a physician's prescription. Period. The AbbVie Hep C cocktail contains a pill (ribovan or something like that) which has caused side effects in prior Hep C patients, so perhaps that angle can be used to fight this new edict from Express Scripts. Gilead's Hep C medication is just one pill (Harvoni) with no recorded side effects and a 100% cure rate. Express Scripts has suddenly decreed that my uncle will be forced to take an inferior medication to what he's already been prescribed, based on cost.

    This will indeed be a fight.
  • edited December 2014
    Hi @PopTart,

    This note was part of a notification related to a pharma stock we currently hold.
    'Course, I don't know if this product (FDA approved on Dec. 19) would relate to your uncle's circumstance.

    short article link

    Take care of you and yours at A-squared, and enjoy the holdidays with your young'ins; as the clock will move too fast and soon enough they will be taking drivers ed. classes.

  • edited December 2014
    Thanks Catch. The bottom line is that my uncle has to take the Abbvie cocktail of pills instead of Gilead's Harvoni pill.

    This conclusion was reached by my uncle's physician, not by Express Scripts as we have still not been able to get through to Express Scripts' horrible customer service. Even though Express Scripts had approved my uncle's Harvoni prescription on Dec. 5 to begin use on Jan. 5, Express Scripts' edict from yesterday stating that they won't cover Harvoni beginning Jan. 1 has forced my uncle to change from a superior cure (Harvoni) to an inferior cure (Abbvie) which includes pills which may cause painful side effects. My uncle's doctor said that he can't get the date of the prescription moved up so that my uncle could begin Harvoni this year.

    It's my sincere hope that Express Scripts is subjected to a massive legal attack costing Express Scripts billions. That would be the best Holiday gift ever!

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