Hepatitis Forums
Hepatitis C Main Forums => On Hepatitis C Treatment => Topic started by: catladyx on March 18, 2015, 10:26:50 am
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Hello all. I was diagnosed in 2012, and have been waiting for a drug that didn't require Interferon shots. I heard about Harvoni and decided it was time to give it a chance.
I'm Genotype 1a. When I had my biopsy after diagnosis they found no fibrosis/cirrhotic tissue. Just mild inflammation. My ALT/AST levels hover right around normal, just mildly elevated. I am sorry I don't remember the last scores, but will have new lab results soon and I will share.
I saw my doctor yesterday and he was glad I decided to try this new treatment. I'd like a place to chronicle the process so I hope it is Ok to do so in this thread. I had a Hepatic panel done yesterday and an ultrasound done today. i have a script for Having to take to the pharmacy. Doc said it will be rejected multiple times, but they will keep trying to push through the approval for insurance to cover it.
I hope, desperately, to be approved to take the drug. If I am, I look forward to sharing the experience with you. Thanks.
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Hi catlady,
Keep fighting for treatment, Harvoni and others available now!
it's better to fight for treatment than to wait that's for sure!
Good luck and stay the course,
We have a common enemy, we fight as one...
God bless
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Thank you, BubbaT!
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Welcome and best of luck with your approval process.
With no fibrosis or cirrhosis many insurance co are not approving, but keep fighting for tx.
Get a scan if possible and Vl count and have your doctor advocate for yyou.
I was rejected over a 90 day period and then offered a different drug (Viekira Pak) and Ive been documented positive for 15 plus yr, F2-3 and Vl about 6mil and they still try to hold off tx since these new drugs are so expensive.
The good thing is if you are no fibrosis even if you have to wait a while until they are more easily approving the Harvoni you should do fine.
Best of Luck i hope you can get it.
Im 11 days into tx and its a easy run
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Thank you, SixFootFour!
I know I shouldn't get my hopes up. I may be rejected. But, I am so excited, so much more than before, that someday I could be rid of the dragon. I really hope I can get the medicine. I feel so *ready.*
I'm going to try to stay positive and be healthy, no matter what.
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An Update:
Doc's office says accredo has all of my info and things have been smooth so far. Hoping for the good news soon that I might get this medicine. I hope so.
Lately, my joints have been hurting pretty badly, and I am always tied. I know it's the disease - praying I can be rid of it.
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Don't forget about Gilead support path. They are the real deal if you qualify.
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Hi catlady.
One important note, is to make sure you tell your Dr. About ALL the symptoms you
Have, especially mental fog, which could be HE, which is one of the Extra Hepatic manifestations that are Listed in the qualifiying conditions to expedite treatment.
The insurance approves you based on your liver damage, if you have recent tests, CT, fibrosure, fibroscan, ultrasounds, biopsies, the more detailed results will help you get approved sooner than later,
Some insurers cover Harvoni even with a F0-F1 score, and some try to give you other meds including ribraviran and solvaldi...
I open you don't have to wait long...
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Update - tons of red tape and push back from accredo, express scripts, and insurance company. As expected. Back to square one.
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Well, I got my denial today. No Harvoni for me. They say I have no fibrosis. It's ridiculous, that i can't get better because I am not sick enough. I am so depressed!
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Don't give up. Appeal the decision. If the appeal is rejected you can then go to Gilead "my support path" and request Harvoni for as low as $5 co-pay. You must meet some income qualifications but you will be able to get it if you qualify
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I looked into My Support Path, the forms require a section to be filled out by the doctor so I will ask them to do that.
My doctor says he can't appeal because my biopsy showed no damage.
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I wonder if, in a few years, the cost for Harvoni will ever come down.
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Please don't give up. Ask your doctor to fill out the paper work
I'm guessing the cost is going down every day but will it ever be affordable to just buy?
I hope you get it. Keep in touch with this forum because the people here are very knowledgeable. There is a patient advocate site that helped some people get Harvoni. Will you insurance cover any of the other drugs?
Good luck and keep us posted. Maybe change your post title to "Ready for treatment but denied Harvoni what next?." or something like that so you can get more feedback
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Catladyx
Dont give up, I went through everything too with denials from Express Scripts and B?C. In my case and from what Ive come to understand is you have the best chance from Express SCripts for Harvoni if you are F3 or more. I know its ridiculous to think that you have a chronic illness that they have treatment for and in the USA you can be denied because you are not sick enough but it seems that is how they are handling it at this time due to the high cost of treatment.
I know most of us fought for or held out for Harvoni due to is 1 pill a day ease and least amount of side effects , but in my case I had told my Dr if I was denied again Id accept the Express Script alternative choice medication of Viekira Pak (almost exactly same success stats but more pills a day, more testing during tx and possible side effects than Harvoni)
You may want to follow up with a call to Express Scripts and see if they will approve Viekira Pak. In my case I was denied a few times for Harvoni and then on the 2nd or 3rd request I received a letter from Express Scripts that Harvoni denied but I could get Viekira. I looked into it and found all of the info why Express Scripts was leaning to Viekira , the discount deal they made to use it as their 1st choice of Hep C treatment for a estimated 30% discount on their cost of the drug etc. Id call and speak to a Patient Rep with your denials info and dx and if it works the way it did for me they will offer you Viekira. As I already said I was ready to acept it but my Doc insisted to wait and I was one of the lucky that got Harvoni approved, but then when I tried to order the second bottle it started again and Express Scripts said they had not approved it and on and on but finally got it again worked out and am int 6 weeks tx now with only $ 10 out of pocket.
Hang in there and keep te requests going to the insurance and Express Scripts or try Accredo as they would be the one to send it for Express Script anyway.
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Try this email address it is a back door for help to express scripts that gets you to real people.
ExpressRxHelp@express-scripts.com
I was denied initially but I am F4 cirrhosis still the people who answer th eemail may be able to help in some way.
Also I believe you have to be denied 2 times by your insurance to get help from My Support Path so you have to appeal and be denied then you can get help for them to pay but they also provide help to get you approved in the first place.
I would give support path a call 1-855-7-MYPATH (1-855-769-7284) for assistance
Support Path can help your patients get started on therapy and move toward treatment completion
http://www.mysupportpath.com/getting-started
Benefits investigation and prior authorization support to help determine coverage and eligibility for patients. View a sample Summary of Benefits form to see possible investigation results.
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Hi Catladyx,
I feel for your troubles, I believe the rule here is that most of us are rejected at first for meds, but we fight and find a way around this. I was rejected twice. It was over ruled by a medical board, because I have tested positive initially with Antimitochondrial antibody positive, and may have PBC, primary biliary cirrhosis. Though the other testing for PBC came in negative, my doctor used this screening during the appeal, and I got Harvoni. The numbers for PBC are now in a normal range and the thought is I do not have it, we will run tests again and see.
Is there anything else in your medical history that your doctor could use to make your case for Harvoni?
When I was getting ready to go to support path, which I ended up not doing as my denial was overturned, I got busy and got all my paperwork together for Support Path which included.
1 proof of income for house hold - under 100,000? but that fluctuates according to number of people in household.
2 copy of Ins card front and back
3 the intake form, which is on the support path website
4 1st and 2nd denial letters
5 proof of citizenship, drivers license, or passport, etc.
6. cover letter - talk a little bit about what you are going through and how you need this medicine.
Create a file, make copies of everything, I also saved it all to PDF. Be organized, it makes the job of the analyst easier to do.
Don't give up, you will get there. Keep us posted.