Hepatitis Forums
Hepatitis C Main Forums => Hepatitis C Research News & Studies => Topic started by: lporterrn on January 05, 2016, 05:26:29 pm
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This is from NATAP:
United Healthcare appears to have removed the restriction requiring cirrhosis and additional major commercial insurers appear to have broadened coverage. It appears UHC and Anthem now allow F0-4, although UHC still maintains a restrictive substance abuse policy. Several commercial insurers appear to have have no fibrosis restriction: Cigna, Aetna, Humana, CVS, Optum.
https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Pharmacy%20Resources/Med_Nec_Harvoni.pdf (https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Pharmacy%20Resources/Med_Nec_Harvoni.pdf)
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WOW!!! This is some of the best news I've heard so far this year! This may well be "the year" that a lot of people are finally able to get this HCV behind them. Thanks for the info, FT
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-just want to add that, thanks to Lucinda's post, on Jan. 6 I asked my hepatologist's nurse if she knew about the change. She said the specialty pharmacy they work with informed them of the new rules at United Healthcare and Anthem, and they were busy resubmitting for a lot of patients who had been denied under the previous rules. Anyone know if the insurers and manufacturers cut new deals to make this possible?
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Thanks for posting this Lucinda! I forward info like this to my infectious disease doc in case he has a client that it could help.
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hmmm...it was UHC that denied me 3 times with cirrhosis. I feel like the first born child in this one, but am happy for my younger siblings. Its about time.
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Beto, I agree this change has taken too long to get here (at our expense!!), but in reviewing my insurance's website, I see nothing as of yet that shows they are changing their F3+ requirement for Harvoni. Daklinza isn't even on their Specialty List. So some of us may still have a big uphill battle on our hands. But so very glad to hear some insurance companies apparently have a brain!! Let's hope mine will soon be one of them. FT
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My clinic has seen 2 denials based on lack of fibrosis since this news went out. It sometimes takes these companies a few weeks to get their act together, and I'm confident this change actually will come.
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Please let me know if you still hear about denials. I saw the actual text from UHC, so I know it exists.
An aside, I highly recommend working with a patient assistance program, such as the Hepatitis C Careline http://www.hepmag.com/articles/2512_20506.shtml (http://www.hepmag.com/articles/2512_20506.shtml)
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Well, I just decided to go the route of an IMR for Harvoni, so should have an answer in the next couple of months. Keep your fingers crossed!!! FT
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Good luck FT...you are so close
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Since Lucinda has posted the link to the United Healthcare criteria, here is a copy of the link Coach Mike posted elsewhere* of the Anthem criteria: https://www.anthem.com/provider/noapplication/f0/s0/t0/pw_e225443.pdf
Thanks, Coach Mike!
*Topic=Anthem 2016 Tx Criteria http://forums.hepmag.com/index.php?topic=3816.0