The McKerron-Ferguson Act of 1945 exempts much of what insurance companies do from Federal Anti-Trust, at least to the extent that such is regulated by the states. There are exceptions such as coercion or intimidation, and in dealing with providers of services. I have not done the research, but the legal question is whether an exclusive contract by a pharmacy benefits manager (not an insurance company) with a pharmaceutical company is exempt. Certainly, insurance companies list their formulary and have discretion as to which pharma they will support and the extent of co-pays. Seems to me that they should reimburse the same amount for competitive drugs and if one is more expensive the patient pays the difference. Nothing wrong with that from an anti-trust perspective. One problem Express Scripts may have is that Illinois, for instance, requires 30 days notice to insureds when the formulary is changed, Here, they gave about 9 days notice. I presume other, even most or all, states have similar requirements.
I assume that your price figures are list price. Or, did you use a discounted price for Viekira Pak? Is the "advantage" you report for Harvoni better efficacy; or, less side effects; or, both? Thank you for your nice post.
Come they told me ..rum a tum tum .....a new born king to see...a rum a tum tum....I am a poor boy, too...a rum a tum tum......I have not gifts to bring...a rum a tum tum......because I bought G. I. L. D.....a rum a tum tum.......
I may be too optimistic, but I have detected a subtle note of civility creeping into this m.b........there have been some really helpful posts from Sono.....lately......hope our m.b. returns to the tenor of a year or so ago......best regards to all
I had been holding Jan 16 calls at 65, 90 and 100 strikes.....10,30 and 30 of those.....total of 70 calls.....today, only the 100s were under water so I bought 20 more.......I think that these are a steal......My first 70 will go into long term gain status in March,April and May of 2015 and I may sell them.....I would like to convert some, so I may hold the 65s until maturity and convert to shares....pretty good price for Gild........I expect Gild to be over 125 by end of next year.....and maybe by July.......they are more than HIV and Hep-c.....this is a real powerhouse and will do very well for a long time, IMO......
First, Scripts will extend out the date to discontinue Gild until January 21 or later as many states require at least 30 days notice for such a change.......It will then depend to some extent on the reaction of the medical community.....if the docs view Gild as being much better, they should be able to write a prescription that will trump the Express Scripts decision for those patients that really need the better drug......avoid side effects, etc.
Illinois Insurance Code requires not less than 30 days notice of any change of drugs covered for reimbursement by managers like ExpressScripts.........my calendar tells me that there are only 8 days until January 1.......at a minimum they must change the effective date.....
The physician must get involved when one treatment is measurably better than another even though more expensive.....the medical community cannot let the pharmacy manager/insurance/employer community dictate which drugs their patients get when there is a measurable difference between treatment choices........whether there are measurable differences is the bottom line question.
I read that orthopedic surgery is less expensive...by large numbers...in India or other developing countries than it is in the U.S.........is it acceptable for insurance companies to only cover such elective surgeries in India??? After all, these are in large part western trained physicians............facetious, I know, but lesser care is less expensive.........Is the ABBVIE product really equal to HARVONI?
Study done by researchers in Great Britain released in August, 2014, indicated that 46 % of world wide patients were genotype 1; 30% were genotype 3; and genotypes 2,4, and 6 were 23%. Less than 1% were genotype 5. Express Scripts covers 25M Americans, or about 7 % of total. There are about 3M Hep C patients as I recall. Assuming half of those are genotype 1 or about 1.5M, of which about 100k would be Express Scripts patients. If the report I read to the effect that ABBVIE drug paid by ExpressScripts was limited to genotype 1 and that Gilead would be covered for other genotypes. There is a lot of assumption in this and I would like to see an analyst who knows the numbers well put out a report on the impact of Express Scripts deal with ABBVIE. I am assuming that earnings forecasts made by analysts have assumed that ABBVIE would take some market share, in any event.
Bought an MacBook Air for my wife in St. Louis on the 15th....asked about how business was and how the iPhone 6 was doing....the response was "excellent"...very busy
I don't recall the details, but I recall that Gilead's pipeline is long and strong......you will have to look and decide. I have January 16 calls at 3 different strikes and will sell most and likely convert some to shares, depending on the price action over the next 6 months. Feeling good about this right now.
Does the ABBVIE product offer any benefit over Sovaldi or Harvoni other than potential price difference? How much savings must there be in cost to insurance companies to justify the patient taking the risks of the side effects? Isn't the ABBVIE market much more limited due to the minimum 12 week protocol, which excludes them from the 8 week protocol market? So, if you are a Dr. you can only really consider the ABBVIE product for a portion of the 12 week market, not all of it. Must those patients in that market be exposed to the negatives of the ABBVIE product? I ask these questions in an effort to learn the real differences of the two products as to strains of hepatitis they treat and the significance of those differences to market share available to ABBVIE. Bottom line, how much of the hepatitis market is available to ABBVIE in their competition with GILEAD: and, of that market, how much are they likely to get? I think that these questions frame the issues and the last one will only be answered in time.
If even a 1% better chance of survival with Gilead over Abbvie, the docs will RX Gilead and shift the risk of loss (law suit) to the insurance companies. The insurance companies will also have to factor in the cost of care for those who fail the treatment...liver transplant, etc.......seems to me that the cost difference of the two choices to be viewed as significant enough for the insurance companies to take that risk. Time will tell, of course, but Express Scripts and others did not get their Christmas wish of a huge price competition between ABBVIE and GILEAD!!!
jbrad: Nice post!!! So good to read a post that is a real contribution instead of the pumps and dumps that prevail on so many boards.......I have Apple and some of the trash on that mb is a real "downer"......Thanks, again.
If what you say is accurate...you may have breached a confidentiality agreement with Chembio. I have never seen a technology company enter into negotiations wherein they disclosed sensitive data (e.g. cost data) without first requiring a confidentiality agreement. You should check that possibility before disclosing such. Other than that, I have no doubt that there is only one ....if even one.....person in this m.b. that has negotiated a vet product with Chembio.....