Does anyone know the mechanism by which all insurance co's will have to provide prescription coverage? In other words, what changes are coming to "catastrophic policies" ? Are the policies going to be required to provide coverage for things that they don't now, like prescriptions, tests or office visits with an corresponding rate hike or what?
Naz, the averaged societal cost per HCV patient is more than $70,000 because more than half the patients are not cured by a single course of the 'Standard of Care'. The cost to the insurance company would not be much lower. When Telaprevir is used, more than two third of naive patients get the SVR with total 24 weeks of treatment. This means that the cost of IFN+RBV used in the triple combo is one half the cost for the standard of care. Therefore, insurance companies would benefit if Telaprevir per treatment is less than $70,000 - the cost for 24 wks of SOC = $35,000. If T were priced below this figure, insurance companies would be happy to pay as soon as T becomes available.
Standard treatment is a prescription mailed to patient that includes 56 Ribaviran pills (2x day) and 4 Interferon injections (1x week). I believe this cost about $14000. per month. Teleprevir would be added to this standard treatment. The question is how long would it take for insurance to approve Teleprevir? This would obviously affect VRTX earnings.