Linda Nash loves to play with her band, but recently her Hepatitis C is stopping her.
“I have very severe, very intense joint pain,” she said.
She's fatigued and nauseous all the time. Her doctors say three new drugs – the so-called Cosmos Cocktail – can cure her, but it costs in excess of $25,000 a month and she needs three or four months’ worth of treatment.
Her insurance denied it, she said.
“My doctors say they denied it because the combination hasn't been approved in combination,” she said. “All the individual drugs have been approved, but I think it’s the price.”
Dr. Todd Wills of USF Health and Tampa General Hospital specializes in Hep C and said the reason they're so expensive goes beyond the 90 percent cure rate. Wills said the pharmaceutical companies are trying to recoup money spent on research and development, and they know with this drug they have little time to do it.
“If you have a drug like these Hepatitis drugs that will cure most patients in a few months, you have a lot of people that need treatment, but a limited time you will need to treat them,” he said.
Wills said patients can ask their physician to appeal. Linda said her doctor did that, but she was denied again.
Patients can also try the pharmaceutical company’s assistance program.
If that doesn't work, Wills said the only option may be to wait until you're even sicker.
“Most insurance companies, not just private but even state agencies like Medicare and Medicaid, have established for these newer medications some criteria for eligibility for coverage,” he said. “Typically those are measures of if the disease is severe enough.”
But Linda said if she waits any longer her liver could begin to fail. She’s already having trouble with swelling.
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