Hepatitis Forums
Hepatitis C Main Forums => Considering Hepatitis C Treatment => Topic started by: seanT2 on July 23, 2016, 07:05:36 pm
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Hi, so my situation is this. I'm currently working a job that uses United Heathcare insurance. I failed treatment years ago and have been making strides in attempting to get Harvoni. I'm healthy and my liver is in good shape. From what I can tell, odds seem good that I'll be approved. According the requirements they list, I fit the criteria. Either way, my gastro said I should know in a couple weeks.
Here's the sticky wicket. He said that they would doll out the prescription a month at a time. The reason this isn't ideal is I hate the job and have a possible out with a friend's place of employment in a month or two. I was counting on them giving me the 12 week supply and even if I switched employers, I could use whatever insurance I wound up with I could have the rest of my labs done.
I don't take approval lightly and realize it's difficult if it happens (though he said with prices coming down he's seeing more approvals) am I stuck if they say yes? Has anyone had experience with United or another insurer with getting the supply up front?
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Hi SeanT2 and welcome to the forum! I finished my 12 wks of Harvoni in May and each 28 day supply came separately to my house via Fed Ex. I haven't heard of anyone getting their 12 or 8 weeks worth at one time. If others have, hopefully they will chime in here.
This drug is so expensive that if you can get approval, perhaps sticking it out at your current job until you get that 3rd bottle is worth it! The Specialty Pharmacy should call you towards the end of each bottle to inquire into any problems, etc. before you get the next. So it sounds like you may get the first bottle in August; then the second in Sept.; and then the last in Oct. Once you get that 3rd bottle, you should be "good to go", literally.
I had to fight tooth-and-nail to get this drug and had to take my denials to my state insurance board to make my insurance co. (Blue Shield) pay for it. So ---- if you can get it approved the first time around, I'd take it! I know toxic work environments are the pits, certainly had a few of them myself during my career -- but give this careful consideration before you change insurance companies. Good luck, FT
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Hi Sean.You might want to find out what insurance your friends company has and put it on hold until you're sure what you're going to do.This isn't a "have to do right now" type of thing so you have wiggle room.Just a thought
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seanT2, I have the same ins and have to go through the whole long refill process over the phone every month, I told them every thing is still the same and still go through the long process. Think its because its so expensive and they want to know about any side affects. Their covering their butts so it doesn't get sent to wrong address.
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I have BCBS and Express Scripts for prescription medicine coverage. They required me to use their pharmacy receiving my meds via UPS or FedEx. One month at a time would not refill until I had less than 10 days of medicine remaining. I work in the evening and did not want $33,000 worth of meds sitting in my front porch so I was late to work a couple of times and was napping by my front door at others so I wouldn't miss the delivery.
I finally figured out I could have them deliver to a UPS store so I could pick up there. I was on treatment for 6 months of worrying about getting my meds.
Good luck
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Thanks everyone. So from my understanding they place the call within 10 days of refill then ship you out the next month? If that's the case and it's in the mail a week early, then I'll try to stick it out for a bit longer. I should know either way this week.
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For me I had to call them. They would ask how many days I had left not remembering if they wanted to hear 10 days or maybe it was 7 days but whichever they would then ship. As I remember it was 2 day shipping. I starting fudging the number of days remaining on hand so I could get my refill a bit sooner so less stress
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Found out today it was denied and they want to go Viekira Pak. Honestly debating if I just want to wait it out for better medication at this point.
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SeanT2, so sorry to hear re: the denial. I guess that's why I was suggesting that if UH had approved readily, then to take it and stick it out at the job. The price of the Harvoni is a sticking point, unfortunately.
What is your genotype? I ask because if you are 1a, you would need to also take ribavirin w/ the Viekira, which adds a whole other list of possible sides. But I see you're also treatment experienced, so that plays into it, too.
Another option could be generics -- quite a few members here have had great results w/ them. There's a lot of info on this site about that option, which may help you.
Hang in there and hopefully your doctor will assist you in appealing or finding another option. Keep us posted, FT
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I'm 1a so I'd need the ribavirin. I honestly don't know if it's better to just not take the meds now or just deal with it. Like many I just want this over with.
I've been looking into generics, is there an option that doesn't require international travel?
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First, are you going to appeal the denial? I know that is not what you really want to do, but if you have the energy, see if your doctor's staff will help with appealing. I ended up being denied 2x and that's when the only other option was going to my state's insurance board for a review. That's how I finally got the medication. So if you are willing to appeal (and I would!), usually you need 2 denials prior to going to the state.
Re: generic info, another member, Coach Mike has written extensively here on generics. Just scroll thru the topic list under this category (considering treatment) and look for his posts.
Also -- as a 1a, you could also take Daklinza or the newer Epclusa....... does your doctor think either of those might be approved? I wanted to avoid the riba if at all possible, thus why I fought for the Harvoni. There's no riba with either of the above for our GT.
Your doctor's office will hopefully be willing and able to help you with these denials. I was so fatigued when I received mine, I know there is no way I could have gotten those appeals done without their help. They should be able to assist you with this. Again, hang in there, and fight for this medication! FT
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It was just someone from the office that said "they denied it, we're going to try Viera Pak." There wasn't much conversation and I didn't speak to the doctor. I was hit with a medical bill that could have just gone towards the generic price when I got home too. It's just a shame to have to choose between feeling like crap for 12 weeks or getting this taken care of.
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I feel your pain with all this, it was a real battle for me, too, and is so unnecessary. All this does is drain you -- I remember all too well. But it will be worth it to try to get cured of this beast if you can.
Viekira came on the market shortly after Harvoni and that manufacturer made a much better deal with the insurance companies -- thus why when Harvoni is denied, seems a lot of docs then suggest Viekira. My doc did too -- we had some long discussions about this and I just stood my ground that I did not want to take ribavirin if I absolutely did not have to, as the whole point of me waiting for 5 years to treat was to take safer and more tolerable drugs. It was already scary enough to take a new antiviral that had little long term study. But this is just how I felt, many people have had very manageable sides with the Viekira + riba and were cured (our ultimate goal). So, it just boils down to what you are comfortable subjecting your body to. Hemolytic anemia is very common with the riba and I just did not want to deal with that if I did not have to.
The Epclusa has just come on the market at $20,000 less than Harvoni, but I don't know how that's working out with the insurance industry right now. Talk to your doctor about all this -- we now have several options for 1a folks and that is a wonderful new development! FT
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I talked to the pharmacy today. It looks like it's kosher to put in an order with a week and a half supply left. I'll have my first on the 9th and looks like my next order will be around the 25th for Sept. Though not the medication I wanted, if I can still work it out with leaving the job in oct, I can deal I guess.
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Congrats on having the decision made! Glad this part is now behind you and you will moving forward towards SVR. Keep us posted, FT