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Arena Pharmaceuticals, Inc. Message Board

  • foreverlong07 foreverlong07 Sep 18, 2013 4:01 AM Flag

    Insurance Coverage for Belviq

    Is there any way to track the insurance company's that are reimbursing for Belviq? Anyone keeping a list? We all know this is an important part of the strategy.

    Sentiment: Strong Buy

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    • Repost from last month. Will update sometime this weekend:
      Formulary check on the top 25 health plans (USA Today):
      ESI/Medco: non-preferred
      Aetna: Tier 3
      Humana: Group D (RxImpact plan-Belviq newly added since I checked last month!)
      Blue Shield of CA: Prior Authorization required
      BCBS of MI: non-preferred (step therapy required)
      BCBS of NJ (Horizon): Tier 3
      Lifetime Healthcare: Tier 3 (PA required) Less

      Sentiment: Strong Buy

      4 Replies to gawaine43
      gawaine43 • Aug 9, 2013 10:47 AM

      Now concentrating on California/employee plans:
      Medi-Cal (California's Medicaid - huge!): Tier 1 (PA required)
      Caremark (Primary/Preferred): PA required
      Delta Air Lines: Tier 3
      Ford Motor Company (UAW): Tier 3
      GEHA (Government Employees Health Association): Tier 3
      GEMCare Group Health: Tier 3
      Lockheed Martin: Tier 3
      Loma Linda University: PA required
      Microsoft: PA required
      National Pharmaceutical Services: Tier 3
      Public Employees' Retirement System: PA required
      PrimeChoice Accord (National): Tier 3
      Robert Bosch: PA required
      RxAmerica: PA required
      SAMBA Federal Employee Health Benefit: PA required
      San Diego Unified School District: Tier 3
      Sears: Tier 3
      SuperValu: Tier 3
      Time Warner: Tier 3
      Verizon: Tier 3
      Wells Fargo: PA required
      Whirlpool Corporation: Tier 3

      Please note that while these institutions may be large/well-known, CA is dominated by Kaiser & Anthem Blue Cross (about 2/3 of *private* insurance). Blue Shield CA (3rd-largest at 15%) does cover with PA.

    • The thread of comments below indicate that it will be difficult to list the insurance plans covering Belviq to date. One interesting point among many brought up in the thread is that insurance will look at the cost/benefit of Belviq. And, to that point, it now appears that the Belviq produces in reality a level of efficacy that is much closer to the placebo adjusted 8% to 11% as opposed to the 4% often quoted by the Orelli's of Motley Fool, Adam Fraudstain, Kramer etc. Eventually, Belviq responders will carry the day, and will be saying, "well, my weight loss with Belviq was much greater than 4%!" The question is, how will medical directors of insurance companies learn sooner than later, what we already know?

      Sentiment: Strong Buy

    • If your work/employer have and set up good benefit you will get reimbursed with everything out of pocket for copay and prescription, like mine.

    • I was just got approval from CVS/CAREMARK today....they are actually the carrier for my prescription meds....
      $81.51 for a months supply...had MD send in a pre authorization form form off their website...

      Sentiment: Strong Buy

    • If obesity is a disease and a cure is noted by the could it not be covered. When VVUS goes belly up Belviq will be the only game in town to combat this disease. Approved by the FDA and already being distributed the AMA should make the recommendation. This should leave no doubt in the minds of every insurance company in the world......all you hedgies hear that ...on its way.

    • PEOPLE! Eisai just guided that insurance coverage will increase from 39% to 50% by YE...20% increase is great! Plus Eisai has 50 people just dedicated to getting more insurance companies on board, and with the diabetic benefits of belviq it will happen alot sooner than we think

    • Medical health insurance groups don't just start covering new drugs because they became aware of it through reading FDA drug approvals. They review new drug coverage issues in a very timely and tentative way with study on financial impacts vs. patient obese population profile under their health plans. Review staff has a schedule to address new drug coverage. It's still all about the money, and patient safety, and they want to be on the right side of both issues.......short version, it takes time to wade through the system of coverage. No doubt, the consensus across the board for obesity treatment is positive in the health industry. The process still takes a length of time, and investors need patience when expecting a speedy coverage result. Eisia knows the process, and has already outlined reasonable goals for percentage of their judgement on this. I believe they have under estimated their coverage goals to achieve better progress as they report to their shareholders on a quarterly basis.

      Sentiment: Buy

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