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Author Topic: Denied Harvoni after first 4 weeks , what next ?  (Read 16027 times)

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Offline Mott the Hoop

  • Member
  • Posts: 12
Denied Harvoni after first 4 weeks , what next ?
« on: January 26, 2015, 11:09:13 pm »
Changed insurance Jan. 1 after starting Harvoni Dec. 30 .United Healthcare has denied my treatment going forward . I have 1 pill left out of 28 , usually take at 8 pm . No way I'm getting anymore tomorrow w/ snowstorm . Have started appeal after dozens of phone calls & being on hold for hours the past couple of weeks . I saw this coming but trusted doc's office and pharmacy to come through , didn't happen . Should I split the last pill in half for tonight & tomorrow or maybe take it in the am 12 hours late to get me through tomorrow ? What can I expect from this sudden stop in treatment ? Any advice going forward ? Any people or phone numbers I could call who may help w/ appeal to United ? Other than my Doc & pharmacy who I'll be tracking down the next couple days . Will stopping suddenly make going to ER a possibility ? Do they have an emergency Harvoni supply ?




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Offline Lynn K

  • Global Moderator
  • Member
  • Posts: 4,546
  • Get tested, get treated, get cured, fight Hep c!
Re: Denied Harvoni after first 4 weeks , what next ?
« Reply #1 on: January 26, 2015, 11:45:28 pm »
Is it possible the pharmacy could give you an emergency pill or two?

I have seen on other sites not to split the pill so I would not recommend that.

You shouldn't feel anything if you miss a dose the only problem is with your treatment might not being as effective. Have you called your doctor about this question of how missing a day or 2 would effect your treatment outcome?

Just keep calling everyone

Good luck
Logged
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline Mott the Hoop

  • Member
  • Posts: 12
Re: Denied Harvoni after first 4 weeks , what next ?
« Reply #2 on: January 26, 2015, 11:55:55 pm »
Thanks Lynn , I'll take the last pill about 8am tomorrow, won't split it , that will be 36 hours between #27 & #28 . I'll certainly ask pharmacy for an emergency pill or two . I'm not optimistic about getting ahold of anyone in this storm tomorrow, but I'll try . Doc's office says expect viral loads to spike if I stop this soon . Maybe things will look brighter in light of a new day .   :)
« Last Edit: January 27, 2015, 12:07:20 am by Mott the Hoop »
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Offline Mott the Hoop

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  • Posts: 12
Re: Denied Harvoni after first 4 weeks , what next ?
« Reply #3 on: January 27, 2015, 08:52:10 am »
Stopping after 28 days , what can I expect ? Will there be any consequences to treatment in future or side effects the next few days coming up ? I need some talking points to use in my appeal .
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Offline Lynn K

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  • Posts: 4,546
  • Get tested, get treated, get cured, fight Hep c!
Re: Denied Harvoni after first 4 weeks , what next ?
« Reply #4 on: January 27, 2015, 03:07:32 pm »
I wouldn't expect an symptoms as a result of stopping treatment you won't feel different. What I would say and this should more so be from you doctor is that this could jeopardize your success of treatment and be throwing away the money already spent to treat you if your treatment should fail. There is no 4 week treatment if you do not continue your meds they will have thrown away the cost of that one bottle and could possibly cause resistance concerns for any future treatment.

Another resource is Gilead's My Support Path they can provide help in dealing with your insurance and provide expert information about the consequences of stopping treatment at 4 weeks

http://www.mysupportpath.com

call 1-855-7-MYPATH (1-855-769-7284) to learn more about resources that are available to help patients along the way toward treatment completion
Logged
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline Mott the Hoop

  • Member
  • Posts: 12
Re: Denied Harvoni after first 4 weeks , what next ?
« Reply #5 on: January 27, 2015, 08:59:11 pm »
Thanks again Lynn ! :) Your thoughts are both helpful & reassuring . I did talk to the folks from mysupportpath earlier today & they were friendly , understanding & very supportive ! :o After the whole state was shut down today I'll be back in touch with Doc's office & pharmacy hep c consultant first thing tomorrow . They both have been working hard on my behalf & may be almost as frustrated with the insurance people as I am . I'll report back when I learn more . I feel like I have a team of support working with me now & I appreciate it very much . Any future feedback or advice is welcome . Thanks in advance , Mott the Hoop  8)
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Offline amy1662

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  • Posts: 41
Re: Denied Harvoni after first 4 weeks , what next ?
« Reply #6 on: January 27, 2015, 11:11:10 pm »
So sorry to hear you are going through that Mott The Hoop. Lynn is giving you good advice. I went through some issues getting my last bottle of Harvoni because my Aetna plan changed New Id New Copay. I knew early on about this change and spoke to Aetna who assured me I would not have an issue. They said my Harvoni would carry over to the new plan. I was surprised to see them put me through another authorization when the change happened. My pharmacy sent me a weeks worth of Harvoni to hold me over while everything got straightened out. Your prescription was already authorized and the fact that you started treatment already your new insurance should have honored that without a denial. Did they give you a reason why?  Something is not right I hope My Support Path and your doctor can straighten it out for you in the mean time try and get the pharmacy to front you some pills. Please let us know if you were able to get your pills, Amy
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Offline kate0b1

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  • Posts: 293
Re: Denied Harvoni after first 4 weeks , what next ?
« Reply #7 on: January 28, 2015, 06:33:45 am »
@mott the hoop, good luck this morning getting this figured out, you actually seem pretty pulled together about this, i would probably be freaking out. I am pretty sure amy got meds sent to hold her over (is that correct guys?) until they out it straightened out. i don't know if stoping/starting treatment would be a problem does anyone know anything about it?

kate
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Offline Mott the Hoop

  • Member
  • Posts: 12
Re: Denied Harvoni after first 4 weeks , what next ?
« Reply #8 on: February 05, 2015, 09:21:09 am »
Back on Harvoni after missing three days . Had to push hard at anybody who would listen for an expedited appeal ?! Received a call from insurance people day after having denial overturned & being approved for 8 more weeks . Lady was pleasant but offered no apologies, instead advised for future reverence to not submit P.A. forms (prior authorization) on a Friday because Medicare law insists on a 72 hour answer . Apparently weekends count  . Quite a lame response considering Doc's office had submitted paperwork & my history 3 times in the 2 weeks prior to denial ! But I was in no mood to complain further , knowing my medication was finally coming later in the day . Looking back last week was a nightmare , I don't know what finally got insurance to reverse denial , I talked to at least a dozen different people & was put on hold for literally hours . I managed to stay calm through most conversations , not easy , perhaps when I mentioned seeking advice from a patients rights advocate attorney that got someone's attention . It could have been the pharmacy 's help or the folks at mysupportpath.com , but Doc's office called & said I don't know what you did but they're asking for paperwork again & had a different fax # & contact person ! Thanks to all here in this forum for advice & support & listening , it was a great comfort not feeling alone in this disease & now hopefully cure ! :) Mott the Hoop 8)
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Offline Long_Haul

  • Member
  • Posts: 161
  • Slayed the Dragon
Re: Denied Harvoni after first 4 weeks , what next ?
« Reply #9 on: February 05, 2015, 11:37:09 am »
Awesome Mott! We are our best advocates. Good job making enough noise to get back on track. Hopefully you will be alright with the missed doses. Time will tell.

Best of luck,

AL
Logged
Genotype 1A

Diagnosed 1989
Biopsy-cirrhosis stage 4 2000, no starting VL this round

3 rounds of Int+Rib
(Combo/48wks,Peg/26 Wks,Triple with Incivek/16wks)
UND with Incivek, Relapsed
Started 12 weeks Harvoni and Rib Jan 2nd,2015
4 weeks Undetected
8 weeks Undetected!
EOT at 12 weeks Undetected
EOT at 24 weeks STILL UNDETECTED
Completed TX Mar 26th,2015

EOT plus 4 weeks UNDETECTED
EOT plus 12 weeks UNDETECTED !!!!!!!!!!! I am DONE!

NO LONGER a member of the "WAITING GANG"

Offline ma snart

  • Member
  • Posts: 65
Re: Denied Harvoni after first 4 weeks , what next ?
« Reply #10 on: February 05, 2015, 12:04:38 pm »
My wife Helen missed a single dose due to a ruptured appendix surgery, it seemed that from week 5-8 Viral load sort of just hovered at less than 100, and then on week ten finally went to UNDETECTED, not positive the missed dose caused this as she has cirrhosis, but prior to the surgery she was experiencing rapid viral load declines, I thought sure she would reach that goal by week 6, and when that day arrived I began to worry, at week 8 she dropped to VL of 22, which helped with anxiety until week 10 finally got her to UNDETECTED.
So I think you will be fine in the end with many remaining weeks of treatment still to go.
Snart
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Helen 54 yr old female
Geno 1B since 84 from transfusion
started Harvoni on 11-22-14 with 8.5 million viral
After 8 days 933 viral and normal AST and ALT
Week 10 viral load  UNDETECTED
Week 17    detected 19
Week 18    detected 21
Week 20    UNDETECTED   Doctor did prescribe Ribavirin, but have not taken it yet as we are thinking that weeks 17,18 had to have been mishandled.
All other test have shown normal levels.
Week 21 results  on Tuesday 4-21
Week 4 post Harvoni 24 week plan UNDETECTED!!

Offline Mott the Hoop

  • Member
  • Posts: 12
Re: Denied Harvoni after first 4 weeks , what next ?
« Reply #11 on: February 07, 2015, 09:12:45 am »
Thanks Al & Snart , appreciate the replies & support . I'm starting week 6 now & feeling ok , like I'm back on track . I've asked Doc to run bloodwork again next week to see if there are any setbacks from missing a few days of treatment . Even the folks at Gilead couldn't give me a clear answer , citing a lack of research on starting & stopping at this point . Bloodwork from 2 weeks ago came back & showed I was responding well . I'm starting to take my Harvoni pill earlier in the day now , around noon time , trying to find the sweet spot from feeling fatigued to having insomnia . Also having a few other side effects that I deal with on a day to day basis . By the time I get this figured out 12 weeks will be up ! Drink plenty of water ! Any advice on best time of day folks have found to take this medicine , I know it should be same time each day , would be appreciated . Thanks in advance for any feedback & God bless , Mott the Hoop  8)
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Offline ma snart

  • Member
  • Posts: 65
Re: Denied Harvoni after first 4 weeks , what next ?
« Reply #12 on: February 07, 2015, 12:09:01 pm »
Helen takes hers at 6:30 pm, after supper, she seems to sleep good and awakes refreshed. BTW just received 4th bottle delivery of Harvoni today.
Snart
Logged
Helen 54 yr old female
Geno 1B since 84 from transfusion
started Harvoni on 11-22-14 with 8.5 million viral
After 8 days 933 viral and normal AST and ALT
Week 10 viral load  UNDETECTED
Week 17    detected 19
Week 18    detected 21
Week 20    UNDETECTED   Doctor did prescribe Ribavirin, but have not taken it yet as we are thinking that weeks 17,18 had to have been mishandled.
All other test have shown normal levels.
Week 21 results  on Tuesday 4-21
Week 4 post Harvoni 24 week plan UNDETECTED!!

Offline pete58

  • Member
  • Posts: 8
Re: Denied Harvoni after first 4 weeks , what next ?
« Reply #13 on: February 11, 2015, 01:07:38 am »
I just read your post......it caught my eye. I'm sorry to hear about the issue you are dealing with. Changing insurance companies can certainly throw a wrench in the works.

I just started taking Harvoni today Tuesday. I had met with my doctor Monday to have the treatment explained to me. One thing I was told was that during my treatment, if for any reason I ended up in a hospital I should make sure to bring my prescription with me as the hospitals don't provide this or maintain it in stock.

I hope your able to get this resolved in a timely manner.

Peter
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Offline Mott the Hoop

  • Member
  • Posts: 12
Re: Denied Harvoni after first 4 weeks , what next ?
« Reply #14 on: February 13, 2015, 08:17:23 am »
Thanks again Snart & good luck Pete . I'm starting week 7 now , half way through ! I'm taking the pill around 1:00 PM now after lunch , not bothered with insomnia anymore like I was the first four weeks taking it around 8 at night . Good point Pete about bringing medication with you to hospital , emergency pills are not easy to get . Thanks for your thoughts & advice , back on track now for 2 weeks . I take an hour nap now in late afternoon & drink plenty of water , things are going well , one day at a time !
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