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Re: Cardiologymd post# 196725

Friday, 06/14/2019 8:47:00 AM

Friday, June 14, 2019 8:47:00 AM

Post# of 447240
CardiologyMD:

Thanks for giving us a view from a practitioner's viewpoint on insurance coverage for V.

JT seems to have a different perspective on insurance coverage. Here's what he said at the Goldman presentation:

"As a new drug, we are starting off with the already having pretty good managed-care coverage, considerable portion of our prescriptions currently are off label and the approval rate for managed-care is just a shade under 80%, little over 90% of adult lives on Medicare Part D covered by insurance predominantly tier 2, predominantly unrestricted, and about 80% of lives on commercial insurance covered by insurance. So, again predominantly tier 2, predominantly unrestricted."

For what it's worth -- I'm on Medicare with an AARP/United Healthcare for drug coverage & V is a Tier 4 drug -- so my V prescription is expensive, but I don't care.

My observation is that you (and I) still see a lot of insurance push back on V coverage. This dampens the current numbers that Sam81 provides (Thank you, Sam81, for your reports!). But it also means that the potential for increased script numbers is great -- when insurance coverage in your and my world catches up to JT's world...



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