Confused and need advice

[davidsconfused]

I'm lost and need some advice.  I'm on SSDI (my only income) and I have Medicare Part A and B. I was planning to sign up for Part D and I have to the 7th of this month to do so, so I'm on a deadline. Already I had no idea which one of the Part D plans to pick, although the Humana Walmart looked the best for me and I was I was leaning towards that. Now my doctors office wants me to wait, not sign up for a Part D plan and they will send the papers to  Support Path for Harvoni, which they think will be approved. They think this will be simpler and easier than having to apply through the Part D company, doing whatever tests and other they might want, getting turned down a couple times and then going to Support Path.

Supposedly they know better than I do, but I have three problems with this. One, while I don't need the Part D right now (I'm only taking one drug, it's on Walmart's $4 list and costs me $8 a month), I'm afraid something will happen in the future and I WILL need the Part D coverage. Just a month ago I had to take some antibiotics that would have been $4 on the Humana Walmart Plan, but cost me about $70. Two, if I wait until next year I'll have to pay almost a years penalty each month on a Part D plan for the rest of my life (this isn't huge, though, it would be a little over $3 a month). Three is the biggie though, I'm afraid The Support Path will turn me down because I didn't get the Part D coverage when I was eligible, and I will have to wait another year until I can get it.

I'm seriously confused, don't know what to do, driving myself nuts trying to decide and have to make a decision in the next couple days. I was supposed to call the doctors office back this morning. Will getting a Part D plan screw me up or will NOT getting a Part D plan screw me up?

[lporterrn]

Insurance questions are hugely complicated, and I appreciate your predicament. I suggest you talk to a Medicare assistance person or insurance broker (they don't charge to help). You can also contact http://www.mysupportpath.com/ and ask them if they have any experience with this.

[Mike]

Hi David,

Choosing the right Part D plan that meets your individual needs can be challenging; but it sounds like you have done some research and have found a plan (Humana Walmart) that might suit your needs. That being said, the next question is: Will Humana Walmart cover the cost of Harvoni which is a very expensive drug?

The short answer is: Maybe. Provided you meet their clinical profile for approval (which could possibly include grade 3 fibrosis/grade 4 cirrhosis; documented non-responder to previous treatments; documented drug-free life style 6 months or greater and so on). Please note that you still may not be approved in a timely manner even if you meet the criteria (i.e., lengthy appeals, requests for more clinical tests and so on).  I would recommend calling Humana and discuss their prescription drug formularies to determine if Harvoni is covered and discuss the approval criteria. This will help you in the decision process.

I would also recommend calling the Gilead Support Path for Sovaldi and Harvoni @ 1-855-769-7284, Monday through Friday, 9:00 a.m. to 8:00 p.m. (EST).  This will help you understand the process your doctor is referring to and the folks at Support Path should be able to answer your questions. Make sure you tell them you are permanently and totally disabled and are on a fixed-SSDI income with Medicare Part A & B coverage. Ask them what the income and eligibility criterion is. See what they say. If Part D is an eligibility factor, discuss this with them.

Since you are on a fixed income and unable to increase your financial situation through remunerative employment, you may qualify on paper. This can depend, however on some additional factors. For example: Are you married and does you spouse earn wages/income? If so, how much? etc.

I would start this process tomorrow morning and be prepared to be on the phone for awhile (all day and the next if necessary).

You should be able to get the information by the 7th, though it will be a tight deadline .

Lastly, since you are on Medicare, it would make sense to obtain Part D coverage at some point.

Best wishes, Mike

[lporterrn]

Hi - I just talked with My Support Path - They do insurance verification - they are trained to help you with these questions.  CALL 1-855-7-MYPATH (1-855-769-7284)
http://www.mysupportpath.com/

[davidsconfused]

I talked to Support Path. What I got out of them about whether or not my getting the Part D would affect me getting help from them was "maybe". They also said that I had to apply for all insurance I would be eligible for so who knows? They did  say that with my income if I was turned down by the insurance company they didn't see any reason why Support Path wouldn't pay.

I couldn't get a hold of the person at my doctors office today that's handling this to find out if there was any real reason not to get the Part D, except extra time to get the Harvoni and times up to decide now. Monday will be one day too late. I'm still worried not getting the insurance when I could have will affect Support Path paying and I need to get the Part D this go around so I will be filling in the online app tonight or in the morning.

Doing it this was will take longer and be more trouble, but it looks to me like more of a sure thing, I'll have drug coverage, and not pay the penalty from now on.

[Mike]

Hi David,

I think I would have done the same thing, and signed up for part D. In the long run, having prescription drug coverage can be a real help.

Best wishes, Mike

[davidsconfused]

Hi David,

I think I would have done the same thing, and signed up for part D. In the long run, having prescription drug coverage can be a real help.

Best wishes, Mike

I wanted the drug coverage for "just in case" and "you never know what will happen", especially as effectively it's only costing me $10.48 a month and the thought of paying that years penalty every month for the rest of my life really grated on me.

It's a done deal now anyway. My Part D app has been entered.

[Jane_Clark1]

I am posting for my DH who started w/ Harvoni 3.5 weeks ago. We wrestled with the Medicare issue also, and signed up for AARP's United Healthcare Part D, the "preferred" plan which was the mid priced of the 3 plans at $57/mo. Altho Harvoni is not in their formulary, the Hep C gastro filed for an exception and it was approved a week later. So far for the first 8 weeks, we have a co pay of about 6,000 - United is picking up the rest. We also applied for help through the Patient Access Network the non profit who assists people who are not eligible for help through Gilead Support path( Medicare part D patients are not eligible)
My understanding after a LOT of research is that the sicker you are, the more likely the insurance is going to approve an exception to the formulary for you. Our primary care dr. also said they are more likely to approve it if it is requested by a liver specialist than a primary care physician. My DH has been seeing a hepatologist for over 15 years so that was no problem.
Info on the PAN is here
http://www.panfoundation.org/

I did most of the research into insurance and coverages etc. and hope this info is helpful to others. It is a LOT of paperwork and you WILL get conflicting answers so try to have someone help you who can work through all that.

In the good news my DH after 3.5 weeks is at VL < 12. Fingers crossed!

http://www.panfoundation.org/

[BattleTheBeast]

Hi Jane,

Welcome! It is amazing to think that one little magic Orange Pill can finally do for so many of us what nothing else was able to do in the past. I'm also amazed that one pill can be more expensive than the Multi-pak full of pills but it is what it is.

You are correct, the sicker you are the easier the approvals are but you also can't be too sick (decompensated) for approval either. There's a window you need to be in to qualify right now. I hope your DH continues to progress like he is and that you continue to be so supportive. The support means everything!

Happy Holidays to you and yous, hoping for SVR is 2015!

Mel

[JoanneG45]

Hi, My name is Joanne and I have had Hep C genotype 1a for 20 years already. My consultant recons my liver has cirrhosis now? but my last liver biopsy 2 years ago was not too bad and my viral load was only 660,000. My liver values are not too bad either? I did start seeing a fellow alcoholic I met in AA and he has hep c too. Because I was with him for 6 months can he have passed more of the virus on to me?  I suffer from depression, not drinking and have completely changed my diet to fit in with hep c.
Can I get rid of this. I don't want to die
Joanne- please help. I feel so isolated. London, UK

[Mike]

Hi Joanne,

Merry Christmas and welcome to the forum.

To answer your questions: Yes. You can get rid of Hep-C. The new treatments are curing upwards of 90+, and with new innovations, will only get better. This is the golden age for HCV treatment.

No. Your partner cannot pass more virus to you if you are already infected with HCV. In fact, the chance of contracting HCV from sexual activities is very slight.

Please discuss the new treatments with your doctor - you should be pleasantly surprised!

Best wishes, Mike

[JoanneG45]

Hi Mike,
Thank you that is very reassuring I don't know whether it is different in the UK? My consultant seems to think if I started treatment now it would be Interferon  based and I would be on it for a year! I live on my own and he said it makes you feel like you constantly have the flu and are suicidal!!!
I am seeing him in April with the view to starting treatment in May hopefully for just 6 months. He also thinks that I am borderline hypothyroid and have coeliac disease.
I started having bad headaches and kept going to bed in the day time because I was so tired. All this lead me to a relapse and I picked a drink up. But I'm off that now and closely involved with AA.
Cheers
Jo

[HHburme]

Joanne,

Welcome    These are very exciting times for us heppers. The new drugs are amazing !!  High cure rates, very little side effects. I am day 13 with harvoni, first time treating. Been carrying this disease around over 35 years and have experienced your feelings. I'm also a friend of Bill W for quite some time.

Get into action, call your physician about starting treatment. The hope we have been waiting for has now become reality.

jb

[BattleTheBeast]

Hi Joanne,

Best thing you did for yourself this holiday was finding your way here. YOU ARE NOT ALONE!!! 

There's a ton of knowledge and even better a ton of supportive amazing members. It makes me smile how lost I felt 5 months ago when I heard I had Hep C and F4 cirrhosis with a VL of 8.3 Million. I came here full of questions, scared to death, really really sick and today I am 11 weeks into treatment, at 9 weeks I became Undetected.

It's been a bit of a rocky road for me but with everyone's help and support I made it this far and I will make it to SVR in 2015. I am not alone in my battle anymore either.

So I third what Mike and HH recommended. Go get yourself back to a doctor who can work with you. I am not sure how the medical system works in the UK but you really would want to get to a specialist for Hep C if you can . So you have choices: and Infectious Disease (ID) doctor, a Hepatologist (liver specialist) doctor or a Gastroentorologist ( Liver, Belly, Digestive) doctor. They may even have a Liver Clinic you can go to.  I did a quick Google check and found this http://www.thelondonclinic.co.uk/the-liver-centre or this place https://www.kch.nhs.uk/service/a-z/hepatology and I am sure there are many many more options in London.

It's going to be OK, you are on the right path and doing the right thing. Take a big deep breath and when you are ready start making some phone calls. Your day to day doctor may even be able to refer you to someone he/she works with more quickly; that's worth a shot. When you call in you need to explain how distressed you are over the situation and would appreciate hep as soon as possible. Being polite but insistent and honest should help.  What I did was call in to the doctors office every morning to see if anyone had cancelled so I could get in sooner than my scheduled appointment, it's helps to be nice to the person who schedules the appointments. Don't be a pain but ask them if you can call daily for cancellations, most will be fine with that especially if you ask.

It's really going to be OK, you are on your way to get help and will be getting treatment before you know it. Maybe in a few months down the road you will be the one answering the "easy" questions.

Happy Holidays and smile!

Mel

[Lynn K]

Hi

I think what Battle meant was hepatologist liver specialist then there is hematologist blood specialist but you want a hepatologist.

I think Sovaldi is available in the UK and that is for 12 or 24 weeks depending on your genotype may include interferon or just Ribavirin with the Sovaldi. Harvoni is coming soon I would think 1 pill a day 12 to 24 weeks.

Neither viral load or liver function test show how much liver damage you have there is no correlation. Damage from hep c happens over many years. I have seen it said adding alcohol to hep c is like pouring gasoline (petrol) on a fire just burn hotter.

good luck to you