Why is marijuana a disqualifier for Harvoni?

[dragonslayer]

Why do some insurance companies make even infrequent marijuana use a disqualifer for treatment?  Does it specifically react negatively with Harvoni?  Or does it indicate to them reckless behavior from which they infer that the the recipient is unlikely to obey an appropriate treatment regimen?

[BattleTheBeast]

Hey Paul,

Who knows why they come up with the rules they do but I would assume it's because they don't want the drug going to someone who is going to be "at risk" for using needles or alcohol. Then it would be a waste. Since Marijuana is medically legal in certain places it doesn't seem to be valid but it's easier not to smoke it than it is to fight the insurance Company over it. Once you are on Harvoni I don't think everyone has random drug testing. I haven't heard of it anyway.

Mel

[dragonslayer]

Hey Mel,

The fact that they're equating smoking pot with shooting up seems to be more than a bit of a stretch doesnt it?  Not that I believe theyre beyond such thinking.   Talk about fallacious logic.. Sheesh..  I guess their logic must go something like this:  'IV drug use is a prime causal factor for infection; many IV usuers also smoke pot; therefore, pot use may be used as prima facie evidence of IV drug use; therefore, DENIED'... or something like that.

BTW, have you heard about any negative interactions with Harvoni?

[BattleTheBeast]

Hi Paul,

Honestly I don't think many people would own up to smoking Pot let alone own up to it while on Harvoni. I know smoking anything isn't good for your liver; happy to report I quit smoking cigs over a year ago before i even knew I had Hep C.

The other thing to consider is how new Harvoni is so not much data is available really. We are pioneers in this treatment. Perhaps we have someone in Colorado or someone who has a medical marijuana permit on the forum that can answer you.

For me, I would do without because it's not worth risking anything that could possibly impact clearing the virus. Until there is more data is it worth it? You have to answer that one yourself.

Mel

[dragonslayer]

I agree with you, Mel.  Why take any unnecessary chances.  I only ask because there are a lot of patients who have been on medical marijuana with earlier forms of treatment, and who have found it useful to manage symptoms of HCV.. Because of that, I would have thought that some testing would have been done/published regarding Harvoni.  Ive read where patients on Sovaldi plus peg/riba have been advised that medical marijuana was ok, and even recommended if it aids compliance with treatment.   While symptom management isnt a big issue with Harvoni,  because patients have used marijuana to manage serious HCV symptoms, Im surpised this coupling of the two has not promted further study.

[Mike]

The issue is that marijuana is classified as a Schedule-1 substance under  Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970 (Controlled Substances Act/CSA).

Because of the CSA, and the fact that federal law trumps state law, which the US Supreme Court has affirmed on occasion, possession and/or use of a Schedule-1 substance is illegal in all 50 states and US territories.

Since insurers can establish approval criteria when authorizing a treatment, the industry has developed specific criteria for HCV treatment.

One of these requirements is abstinence from illicit drugs, which are identified and proscribed by the Controlled Substance Act.

Here is a list of Schedule-1 drugs:

2C-B (Nexus, Venus, Bees, Toonies)
5-MeO-DMT (DMT)
Benzylpiperazine (BZP)
Cannabis, Marijuana
Dimethyltryptamine (DMT, Fantasia, Businessman’s Special)
Gamma-Hydroxybutyric Acid (GHB)
Hashish, Hash Oil
Heroin (Smack, Dope, H, Junk, Brown sugar, Horse)
Lysergic Acid Diethylamide (Acid, LSD, Lucy, Blotter)
MDMA (Ecstasy)
Mephedrone (M-Cat, Meow, Bath Salts, Bubbles) (Under New Jersey State Law, “Pamela’s Law”)
Methagualone
Psilocybin Mushrooms (Psychedelic Mushrooms, Magic Mushrooms)
Synthetic (Cannabis, Spice, K2, Herbal Incense)
Tenamfetamine 3,4-Methylenedioxyamphetamine (MDA, Sass, Pink, Yop)
Mescaline and Peyote

Notice that marijuana and heroin are both Schedule-1 substances under federal law.

Because of this, insurers don't have to delineate between drugs within the Schedule-1 classification: All these substances are illicit under federal law and, therefore illegal in all 50 states.   

A resident in Colorado, for example, would have difficult standing in court trying to gain relief from an insurer denying treatment due to illicit drug use, regardless if such use is legal in the state.

This is because federal law trumps state law, and the insurer, with this standing, would appeal any state ruling directly to federal court.

In Gonzales v. Raich (previously Ashcroft v. Raich), 545 U.S. 1 (2005), the United States Supreme Court ruled that under the Commerce Clause of the United States Constitution, the United States Congress may criminalize the production and use of home-grown cannabis even where states approve its use for medicinal purposes.

That about covers it - until marijuana is removed from the Schedule-1 list - insurers can continue the prohibition.

Best wishes, Mike

[dragonslayer]

Thanks Mike.. Another problem with the classification of marijuana is that because of its status, and because its already been determined to have no medical benefit, such studies as would be beneficial to the topic at hand are not permitted....  What a ruse..
Cmon, feds, its 2015 already.. Let's update!

[Lynn K]

Great reply Mike clear and to the point.

I just wanted to add here in WA state a few years back a patient was denied liver transplant on that same basis even thought he had a medical marihuana card and later died from his liver disease.

http://seattletimes.com/html/localnews/2004387955_webmarijuanadeath02m.html

Something to think about.

[dragonslayer]

Lynn, what  horrible story.  It really underlines the need for the federal government to get in step with the states on this one... They're hopelessly behind the times, and its seriously affecting people's lives.

[Lynn K]

My thinking is as marijuana is also another drug our livers need to detoxify we should not use it. Also in light of the fact that it makes getting treatment a problem it is probably wisest to not use marihuana or anything else unless it is a prescribed 100% legal medicine. This is especially important for those of us with advanced liver disease.

I cannot afford the risk to try to buck the system.

[dragonslayer]

I hope you understand, Lynn, I wasnt speaking on behalf of myself, but rather in support of people like those in the article you posted, and in condemnation of the federal drug policies which cause situations like that to happen.

[Lynn K]

Sure I understand that and I don't have a problem with marijuana use personally.

It's just that those of us with cirrhosis do not have the luxury to be fooling around with it and hoping that we are allowed the medicines and life saving procedures we need.

Yes policies should be looked at and reviewed but right now they haven't been so it is where we find ourselves now.

Life decisions change when you are diagnosed with cirrhosis vs early fibrosis.

Best to you

[Mike]

Medicinal marijuana is a complicated subject, with no easy answers. There are ethical and legal issues that arise, and, at times, appear to conflict.

This conflict becomes more murky when employment law is considered.

For example, can a qualified medicinal marijuana user, with a chronic, progressive HCV infection be terminated from employment if that employee tests positive for this Schedule-1 substance?

This seems like an easy question with a quick answer; but it isn't that simple.

In most cases, this employee can be terminated for just cause.

Until the ethical and legal issues regrading medicinal marijuana are resolved in the courts, prohibition will continue.

Best wishes, Mike

[Rubye]

I can't see a thing wrong with smoking marijuana if that's what helps you. My pain doctor was looking for drugs for pain for me that would not be harmful to my liver and offered mj to me but I declined because it makes me feel paranoid. He said it doesn't because the part they use, the THC, doesn't make a person high. I can't see having a problem admitting to smoking marijuana. At all. But then I do live in Oregon, where it was just made legal in the last election.

I think it's legal in most states if used for medical purposes and prescribed by a doctor. Maybe not.

As far as marijuana being bad for you if you have liver disease, well maybe not. --

"Marijuana Smoking Does Not Accelerate Progression of Liver Disease in HIV–Hepatitis C Coinfection: A Longitudinal Cohort Analysis"
http://cid.oxfordjournals.org/content/early/2013/07/03/cid.cit378.abstract

http://www.cancer.gov/cancertopics/pdq/cam/cannabis/healthprofessional/page4

There's a lot more in the way of scholarly or peer reviewed journal articles I've seen before but I don't care enough to search for them myself right now.

I had not heard of insurance using marijuana use as a reason to deny treatment, but am not surprised because they'll do anything they can to save a dollar.

[Mike]

THC, or tetrahydrocannabinol, is the chemical responsible for most of marijuana's psychological effects. THC changes behavior by binding — fitting together like a lock and key — to receptors on nerve cells, which then respond with a change in activity.

Cannabinoid receptors are concentrated in certain areas of the brain associated with thinking, memory, pleasure, coordination and time perception. There are also cannabinoid receptors on nerves in other parts of the body. THC relieves pain, but it doesn't bind to the same receptors in the brain as opioids such as heroin, morphine and other drugs derived from the poppy plant.

[Lynn K]

Hi Mike

Yes complicated indeed. I live in WA state where it is legal but at my company if you have even a minor accident like bump a factory scooter you will be tested for drugs and if traces are found you will be sent to counseling. If you text positive again or fail counseling you can be terminated with no Union recourse.

Like I said I have nothing against MJ but have no reason to use it. If I ever do need a transplant if I did use marijuana it could be a problem. It is a problem for my employment as well so I have never sought medical MJ when it became available and won't be partaking now that here in WA it is legal. But everyone makes their own decisions just my take on my situation.

Hi Rubye

I have seen research on both sides of the argument my personal thoughts are if there is a chemical in my body my liver needs to filter it to remove it from my system so why make my poor beat up liver work any harder than it has to. We all know smoking is hard on the body so wouldn't smoking MJ also? But any way I don't have chronic pain I do have cirrhosis and my decision is based on me and yours is based on yours we all can decide for ourselves how we should or should not use MJ

Best to all
Lynn

[Rubye]

Actually, dealing with chronic pain and having cirrhosis is a discussion for me and my doctor. When you have chronic pain to a point that it keeps you from being able to do simple things like go out and buy groceries or even to take a simple walk around the block, you make a choice between living a life of some quality or protecting the liver at all costs so that you may live a bit longer. Personally, I'll take quality of life any day. The reason I made my previous comment on the good that marijuana can do is I hate seeing only one side of any topic.

[lporterrn]

What bothers me about the disqualifiers for HCV treatment is that they are not evenly applied. I think it is either a ploy to save money or discrimination. It bothers me. It is wrong, but especially so since patients with other diseases don't experience it.   

I get the issue with denying liver transplantation with substance use. There are so few organs and when we donate, it makes sense that we want to donate to someone who will do all they can to keep the organ healthy. Cannabis may accelerate fibrosis. Also, a liver is a huge gift, and it seems right to honor it by minimizing risk.

But I draw the line with our own livers. Marijuana use is sometimes the best option, giving people immeasurable quality of life. Current policies are archaic.   

[Mike]

I couldn't agree more and have worked to push medicinal marijuana referendums in Ohio. I've met countless people with an array of medical conditions - HIV, HCV, chronic pain, cancer, MS, MD, glaucoma - that receive benefits from medical marijuana.

The problem is with the price of HCV medication; and third-party payers balking at the cost and, thus, becoming gatekeepers to treatment.

The other issue is with federal drug laws and the prohibition on medical marijuana.

Nothing will change until 1) HCV treatment costs significantly decrease and/or 2) federal drug policies change.

Best wishes, Mike

[Roger]

My Hepatologist does a "seminar" ever month or two, for people thinking about treatment.  I did his seminar 5 years ago, when Tx was cheaper than today and in that seminar he made it very clear that we need to be 110% clean of "everything" prior to Tx and during Tx.

He said that weed, like alcohol, is processed through the liver and taxes the liver.  It had nothing to do with any insurance company - the rules had to do with the potential success of the Tx... which was/is his ultimate goal.

Even after your Tx ends, you have months or years of liver recovery ahead of you.  To tax your liver is like playing with fire... drugs, fried foods, alcohol, etc, etc.  Is being high more important to us, than living?  If it is, why do the Tx in the first place?

Wanting to get high or be high is a state of mind, as is wanting to live a healthy life.

The choice is ours.

[Rubye]

I don't think anyone was talking about getting high Roger, but rather whether or not marijuana hurts or helps the liver when it is used for problems like chronic pain or a host of other serious medical problems that marijuana helps. As in many things with Hep C and cirrhosis it is about finding that delicate balance between what helps people and what may hurt the cirrhotic liver.

I really appreciate your response Lucinda.

Mike, as fast as some states are moving with legalizing marijuana perhaps the Feds will not be that far behind? At least people are talking about it.

[Roger]

Rubye,

No judgement from me, I'm just saying that it makes sense what they spoke of in that seminar.  Getting high or taking meds that hurt your liver - to me, it's all the same.

Tylenol, ibuprofen, french fries, an occasional drink, and a host of other drugs and foods.  Especially during Tx, I think one should rough it out, rather than tax one's liver.

[dragonslayer]

Roger,  not everyone in treatment has serious liver disease such that 'Tylenol, ibuprofen, french fries, an occasional drink, and a host of other drugs and foods' need to be avoided.  With the exception of the 'occasional drink' which I presume should be outside anyone's repertoire while on treatment at least until declared SVR, these other items may be consumed when needed by some patients not having significant liver damage while on treatment, unless their doctor has advised them to abstain.  General proclamations for everyone in treatment are best  avoided due the vast number of individual differences, and widely diverse states of liver health among this population. 

[lporterrn]

All great stuff. Roger - you are absolutely right about the potential dangers of cannabis. However, it is a slippery slope - are we going to require people to lose weight before they have treatment in order to be sure they don't have fatty liver? No. (Oh God I hope not)

What we have on our hands is a disease that is targeted because of its association with drug use. Traditionally, hep C patients don't organize as a community, so we are easy to pick off. Either organization or litigation will change this, but until then, we are sitting ducks.

[Lynn K]

Great discussion all

Rubye

Just wanted to add I hope I didn't offend you in anyway. You have your pain management issues that you have worked out a plan with your doctor and I hope it is helping you feel as good as possible.

As Linda said about the transplant issue and the article I posted as well that would be a serious catch 22 if a person using medical marijuana is facing the need for a transplant and was unable to qualify which it seems under the present rules seems it would be the case. That is my primary concern about using marijuana for those with liver disease.

Best to all

[BattleTheBeast]

What an interesting topic. I personally feel like alcohol is much more detrimental to someone in so many ways but again that's my personal opinion.

This conversation will go back and forth and each side normally feels very strongly about their own opinion. My thought is that if you have a medical need and it's what is prescribed for you, then use it, how is it any worse than Oxycontin, Interferon or any other legal drug? If someone hasn't lived with Chronic Pain they would have no clue what it's like, just like someone trying to explain to me how they felt when they were on Radiation, I kind of understand and can relate but I didn't live through it. Pot is a much less evil if you ask me than Oxycontin, Morphene, etc.

Anyway until it's actually legal it's a moot point, it going to happen sooner rather than later, the government and the tobacco companies need the income, even the Pharma's will jump on the wagon.

Have a great weekend!

Mel

[Roger]

Not everyone in treatment has serious liver disease such that 'Tylenol, ibuprofen, french fries, an occasional drink, and a host of other drugs and foods' need to be avoided.

I disagree, sorry.  HCV is eating away at our livers 25 hours a day - eight days a week.
Drinking and a basket full of various drugs do the same thing.  To take the drugs or alcohol while the HCV is eating away at you is dangerous.

Anybody stage 2 or greater has enough liver damage, that they shouldn't think about a drink for several years - until the liver regenerates.  Our society drinks. A lot.  Our society is in deep denial about drinking and alcoholism.  Deep.  Frankly - I love the taste and effect s of a large variety of alcoholic beverages.  LOVE... but I will never take another drop of alcohol. It would be stupid, inasmuch as my liver has already had enough alcohol for 10 people and the HCV has done a number on it.

I am "sure" that I am not in a minority here, that many people enjoy the spirits.  I also love life and love feeling healthy, clear, and so on.  It's not easy to give up the drink - as our society pushes it on us all the time...

[dragonslayer]

Roger,

Im not disputing that alcohol and many drugs are bad for the compromised liver.. But you included a lot more than alcohol and drugs in your posts... Tylenol, fried foods, ibuprofen, etc.   Lets remember that ~70% of HCV victims never go on to present with liver health problems/symptoms in their lifetimes...  Ive had HCV for nearly 40 years and both my biopsies show minimal liver damage, ie, < stage1.  And Im not alone..  I realize that im in the lucky minority on this forum, but among the general HCV population, cases like mine are not all that rare if you believe the numbers.  For that group,  I dont think that occasional tylenol or ibuprofen, or occasional fries, etc, need to be avoided.. Moderation is the concept I prefer.    BTW, most doctors will recommend tylenol, or sometimes, ibuprofen, for HCV patients on treatment to deal with the common headaches. Again, Im not talking about alcohol here!

So, while Im not taking issue with your general ideas, especially those promoting healthy lifestyle ( I assume that means plenty of exercise too! )  Im trying to make the case that we arent all in exactly the same boat wrt those food items and over the counter meds we can or cannot take, which is why I prefer to avoid blanket statements; they tend to wind up sounding didactic and judgmental.  The one boat all of us on treatment ARE in is the is the overwhelming desire to reach SVR this year!  To that end, we are all committed....

[lporterrn]

Hi Roger,
We are completely on the same page. Please, please, please continue to promote health. Do I wish everyone with liver disease was 100% clean, sober, exercised, ate a healthy diet, meditated, and so on? You bet! However, they don't. Should we penalize them or treat them?

For me, it all comes down to humane health care practices. If someone had lung disease, he/she would not be required to submit to proof that they aren't smoking before insurance would pay for treatment. But insurance companies are nearly universally requiring proof of zero substance use prior to authorizing treatment for hep C. I know someone in a state where marijuana use is legal. She has debilitating pain. Her doc gave her pain meds, and she felt like a zombie. So, she got medical marijuana and uses very small amounts - it allows her to function. However, insurance won't pay for her HCV treatment. She is willing to endure 6 months of total pain so she can qualify. However,if she had a different disease, she wouldn't be drug tested. To me, something is radically wrong here. Let's help people - not make then feel more powerless and stigmatized.

I appreciate your passion - keep speaking up Roger. Hope you don't mind my passionate reply. I am just having a hard time with the insurance industry right now. I won't keep talking about this on the forum, since I know we are all on the same side. Clearly my morning meditation has worn off!

[Roger]

Hi Lucinda,
All true - thanks!

Can you elaborate on this situation with the insurance companies and drug testing?  When I was approved they never asked me anything about using drugs or alcohol. Maybe my doc wrote something about my none use in his report, so they never asked?

You have a good point with this, and medication for medicinal use.  I see red flags whenever I hear an HCV person talk about "waiting for the day they can do this or that".  Living in a State that has ok'd medicinal MJ long ago, I have seen every excuse in the book for people to legally get loaded.  Frankly, I have never thought MJ should be illegal, but the excuses to use blow my mind.  So I'm a bit touchy on the subject when speaking about potential liver damage.

I would like to understand this issue with the insurance companies better, as I to have an ongoing "hard time" with the insurance industry.

[lporterrn]

Hi Roger,
Many insurance companies are requiring proof of abstinence from alcohol and drugs, and requiring drug testing. Treatment will be denied if this is not supplied or if the test is failed. Your guess about what your doc wrote is a likely explanation. Some of the nurses I know are pulling their hair out because the strict companies want proof. I have no idea how I'd prove that I don't drink or smoke or use.

The real disturbing practice is if patients are cut off because they failed a drug test. These new HCV drugs can form drug resistance if stopped early - it is like stopping an antibiotic too soon, and then a "super bug" comes back.

I think it is good that you are touchy about this issue. Quite honestly, I haven't figured out my position on it since there really isn't good data. For me, I like being free from all chemicals. But I've never had to confront debilitating pain or cancer, and I know it has been a lifesaver for many. Compromising my liver might make sense if I was puking my guts out.

What issues are you facing with insurance?

[Roger]

The only problem I had with the insurance company was their stalling processing my paperwork.  I guess because I explained to all my doc's that I never used drugs and quit drinking 110% 5 years ago that the message was clear - so the insurance never questioned that.

My doc sent my file to them at the appropriate fax number on a Friday. On Tuesday it dawned on me, that I should have heard something as my doc made my order a priory.  I called my doc's office and got clear as to the date and fax number they used.

I then called the insurance company... Was put on hold A LONG TIME, then the guy told me that the doc faxed to the wrong fax number! (what do you bet the fax machines sit side by side?)  He then put me on hold for a lot longer while he called my doc's office to straighten this out.

After an hour++ we got it worked out, and my doc RE-FAXED. 

I called the insurance back in 1/2 hour to followup, to be sure they had the file - at the "correct" desk.  They had it correct, and processed me within a day (I think it was a day).

I then followed up with the doc's office and then the pharmacy.  Frankly, I was polite - but relentless.  I remembered 12 years ago fighting kidney cancer was somewhat the same... nobody cared about me as much as I did - that I had to be my own personal advocate... or die.

I felt that had I not had good 'followup' skills, my file would have sat for whatever the legal length of time was... then they would have asked (probably via snail mail) the doc to fax to the other number - or some other such nonsense. 

Even I lost a few days, inasmuch as I was ignorant of this system of them stalling.  This is an area that I like to inform people, as most people's followup skills are not so good to begin with and the insurance companies take advantage of that.

Every day these insurance companies can withhold funding a drug or procedure, they make money - at least on the float - which adds up for them.

[Mike]

Insurance is pretty easy to understand. Most insurers are for-profit entities, and the less spent on medical care - the greater the profit.

Let's look at insurers and HCV. 70-80% of those infected with HCV will not develop symptoms and will not develop liver damage. Simply put, most will just have an infection.

However, 20% of those infected will have some progressive liver disease, and of those 5% may develop cirrhosis et. al.. This group (the 20%) represent the population that needs treatment.

Because 70-80% of those with an HCV infection don't, from a medical perspective, need treatment, the insurer can delineate between those who 'want' treatment and those who 'need' treatment.

This delineation is reinforced by the high cost of current HCV treatment and the scarcity of medical dollars (note insurers are required by federal law to spend 80% of all premiums taken in per fiscal year on medical treatment). In other words, 80% of dollars obtained through insurance premiums have to be spread across the entire disease spectrum (orthopedic injuries, diabetes, cancer, MS and so on).

Once this is done, the insurer is left with 20% of premium dollars to administer the policies, which includes payroll, fringes, advertising and so forth.

It should also be noted that "...insurance companies are—intermediaries. Health insurers receive payments from employers, individuals, and governments and then send that money to health care providers such as pharmacy benefits managers, doctors, and hospitals, of course keeping some for themselves to cover overhead and, in some instances, profit."

Since an insurance company is a business, it has a fiduciary responsibility  to make a profit which is usually 6-8% per year (provided the company has excellent management and low overhead costs).

Unfortunately, due to the igh cost of HCV treatment, the insurer must delineate between those who 'want' treatment and those who 'need' it, in order to remain a viable business.

This is why insurers can - and need - to set guidelines for treatment approval (e.g., verified liver disease, prohibition on illicit drug use and so on).

Remember: HCV does not occur in a medical vacuum, and, for every medical dollar spent here there is one less dollar spent on other diseases.

Best wishes, Mike

[Roger]

70-80% of those infected with HCV will not develop symptoms and will not develop liver damage. Simply put, most will just have an infection.

However, 20% of those infected will have some progressive liver disease, and of those 5% may develop cirrhosis et. al.. This group (the 20%) represent the population that needs treatment.

Because 70-80% of those with an HCV infection don't, from a medical perspective, need treatment, the insurer can delineate between those who 'want' treatment and those who 'need' treatment.

Since an insurance company is a business, it has a fiduciary responsibility  to make a profit which is usually 6-8% per year (provided the company has excellent management and low overhead costs).

This is why insurers can - and need - to set guidelines for treatment approval (e.g., verified liver disease, prohibition on illicit drug use and so on).

Remember: HCV does not occur in a medical vacuum, and, for every medical dollar spent here there is one less dollar spent on other diseases.

Mike,
All good points and very well said. Thanks.  I do however wonder about the number stated.  When I was told 5 years ago that I have HCV, my hepatologist said at Stage 2 I'll probably die with it - not from it.  Five years later I'm at Stage 3 - moving close to Stage 4... and that movement - from Stage 2 to Stage 3 was with a great diet and 110% no alcohol for those 5 years.

I am not alone, as my hepatologist now admits.  He is so frightened with their old numbers, percentages and so on, that he is leading an effort to make these old facts known to be misleading & what the impacts of that old way of thinking will have on our country.

Additionally, since those old numbers are being proven incorrect there is a lot of new study being done as to the other higher future costs of treating HCV patients.  Treating immediately will probably be proven, quite soon, to keep the overall healthcare costs down - in the future.  Now will the insurance companies follow? Who knows.  Maybe the CEO's will have to take less is salary? 

We keep hearing that there are some 3 million people in the USA with HCV... frankly  those numbers are probably just the tip of the iceberg. Most people with HCV don't know they have it. Many who are sick from it don't know they have it. Nobody gets a blood test for it, nobody (yet) thinks of testing for it, in general.

They keep "thinking" that HCV is primarily a disease of the drug culture, but remember - for MANY years hypodermic needles and acupuncture needles were "reused" &  "sterilized" in autoclaves, which have been proven to be somewhat ineffective for sterilization - especially for needles.

Additionally, in many hospitals reusable needles were placed on trays in bulk, for morning blood tests. Those needles had a tendency to roll around on the trays, and the nurses had margins of error in placement or in taking the next 'clean' needle, as they rolled around as the trays were moved room to room by hand, etc.

Additionally, many nurses, would "rinse" needles out in alcohol when they needed an extra - and call them clean.

Ignorance in the medical field was prevalent.  Just because they were doctors, did not mean that they were perfect (as much as they'd like us all to believe otherwise).  Remember doc's used dirty scalpels, didn't wash their hands and so on in the past.  It took time to understand "clean".

Then we must acknowledge needle reuse in the battlefield and Veterans hospitals in Korea & Viet Nam - as well as in Vet's hospitals in the States. Reuse and alcohol cleaning happened ALL THE TIME.

Then we must acknowledge the ease to give blood - HCV tainted blood. For years.

When these areas are added up, I feel that we have only scratched the surface of this nightmare. Sure, it's easy to point fingers at the people who use drugs and share needles, but one day (soon?) the medical community will let lose with this conversation and then we are going to really see what problem we actually have on our hands!

... and we haven't even discussed transmitting the virus via sexual contact.

I predict they are trying their best to either ignore this or to keep it quiet, as it will put a run on the insurance markets, the like of what has not been seen since the 30's or the 2000's in the banking business.

Not a pretty picture, but I'm afraid a true picture.

[Mike]

There's two sides to the treat now school of thought and the reduction in overall HCV treatment costs. Both have valid points to support each argument.

What will be a game changer, however, is when the price of these new antivirals decrease to the point that it can be demonstrated that the treat-now model reduces health costs.. Unfortunately, this isn't going to happen in the near future.

I would imagine the same approve/deny insurance model will be in place for at least another 5 years.

As far as the old numbers (70-80% of those infected with HCV will not develop symptoms and will not develop liver damage), until these numbers are disputed by empirical-based longitudinal research studies,  they will remain as guidelines in HCV public health and treatment policy.

Best wishes, Mike

[lporterrn]

Mike,
You bring up some good points. Perhaps there are more than two sides to this argument. Looking at the evidence, one could argue that because the HCV-related risk of lymphoma is higher in stages 1 and 2 than it is in later stages, then treating makes sense. Or looking at morbidity data, people with HCV are more likely to die 15 to 23 years earlier from non-liver related causes of death (stroke, cardiac event, cancer, etc).

Or we could look at it from quality of life (QOL). We don't deny treatment to someone with a disease that has low risk of death - we treat it. In HCV's case, we are looking at a disease that has a huge impact on QOL. Depression, stigma, infectiousness, fear of what the disease will do or is doing, etc, are real problems. So, just using empirical data isn't enough.

The sad fact is, the cost of the drug changed the conversation. When interferon-based combo and triple therapy came out, we encouraged people to get treated. But people were understandably reluctant, so this kept the cost down. Now we have a drug that is attractive, and suddenly we need to be sure people are progressing before treating? Cirrhosis is too late.

You are spot on when you said, What will be a game changer, however, is when the price of these new antivirals decrease to the point that it can be demonstrated that the treat-now model reduces health costs. I pray your estimate of the timeline is wrong - You and I will see too many people die or get very sick if we wait too long.

[Rubye]

I have high hopes that things will be better within the year. A lot of what is going on is sorting things out and posturing. Medicaid, insurance and the drug companies are still seeing what they can get away with before someone sues them. Someone in Arizona had to sue to get Medicare to pay for treatment. Medicare now pays.

A huge part of the problem in my opinion is how people with money and influence have no problem obtaining treatment and leave the poor to fend for themselves. Like many problems in our country treatment is very much a class issue. Unfortunately, it is difficult to organize the poor to take a stand for themselves, particularly given the politics that surround Hep C treatment.

There is money to be made on treatment on all sides and meanwhile the most vulnerable suffer as a result of all this gaming. As usual. 

Testing for a drug like marijuana is just one more part of this game.

[dragonslayer]

>> A huge part of the problem in my opinion is how people with money and influence have no problem obtaining treatment <<


Rubye,  Are you saying that people with money get a higher approval rate from insurance companies?

[BattleTheBeast]

I think what happens is people with money have more opportunities to fight for the approval. We all have phones, computers, internet and have easier means with which to advocate for ourselves. We have opportunity for better insurance plans, we have opportunities for more specialists who actually see us and we aren't in a clinic with a PA instead of the doctor. We can pick up the phone and call our doctors and get a call back that same day and if we don't like our doctor well we just switch until we find one we do like.

The medical system is really broken and as broken as it is for those with the private insurance it's even more broken for those with medicaid/medicaid and our seniors. It kind of scares the crap out of me wondering what's going to happen in 10 years when I'd like to retire.

Can you imagine not having a way to call and make a doctor's appointment or what if you got sick and can't even call 911 because you can't afford a phone. Even with government subsidies available especially for our seniors can you actually even get a phone for 12.75 a month which is what lifeline will pay?

Just some things to think about and I found this Forbes article enlightening as well:
http://www.forbes.com/sites/brucejapsen/2014/10/10/as-hepatitis-pill-harvoni-joins-sovaldi-states-erect-medicaid-hurdles/

What is it that makes everyone think Hep C is mostly a Poor Man's disease? I'd like to see some statistics to back this up!

Mel

[Roger]

Battle,
I think the writer of that Forbes article made a writers mistake in that article when he stated, "Sovaldi costs are hitting Medicaid health insurance programs for poor Americans particularly hard because the population of patients in need of Hepatitis C treatments tends to have low incomes and wouldn't be able to afford the drug otherwise", he probably meant that in the Medicaid population, there are a large number of people who have HCV.  He forgot to mention that in a more wealthy population there is also a large population that has HCV.

[BattleTheBeast]

Roger,

Really? Or were you being sarcastic? He forgot? A writer's mistake? Spare me, it's totally the same stigma that keeps many of us from sharing we have HEP C with anyone except for our closest family and friends.

Have you told your employer you have Hep C? If you have you are one of the few who have had the guts to do it without worrying about the repercussions of doing so. If you did you have no clue how it will impact your future with the Company.

It's sad but I imagine it's been way worse for those fighting HIV and the stigma attached to that. I think many people would rather say I have cancer than I have Hep C or cirrhosis and articles like that do nothing to make it any better.

Mel

[Mike]

The issue really has to do with the cost of specialty and orphan drugs and how these relate to finite healthcare dollars.

For instance: FDA approval for new drugs hit an 18 year high (41 in 2014), many of which are specialty drugs. For example, Blincycto, an immune-system booster used to treat leukemia, comes with a hefty $178,000.00 price tag. Myalept, comes with a $325,000.00 annual cost, while Harvoni comes with a $94,000.00 price tag for a 12 week course.

In addition, the cost of generic drugs skyrocketed last year, putting further pressure on the insurance industry and those who pay out of pocket for these drugs.

The end result is that drug costs have increased potential indemnity exposure  to insurers and government agencies - exposures the industry cannot bare given the scarcity of medical dollars which need to be spreads across the disease spectrum.

Because of these pressures, the insurance industries, including governmental agencies have drawn a line with Harvoni, as it represents the largest exposure, with some 3 million potential patients for this new drug.

These costs have captured the attention of congress, and, as noted by Bernie Sanders (I., VT), outgoing chairman of the Senate health-care subcommittee notes:

"We are talking about the need of the American people to be able to afford the medicines their doctors prescribe.There appears to be now a trend in the industry where a number of drugs are going up at extraordinary rates..."

Given the current polarized and dysfunctional atmosphere in Washington, DC,  it's anyone's guess if this issue will be given priority during the next congressional session.

The lines have been drawn and the debate has started between third-party payers and healthcare professionals.

Moreover, there are no easy answers to the complicated situation the American Healthcare industry finds itself in.

That being said, the issue isn't so much who has more money to fight for approval; it is that the insurers - including Medicaid and Medicare - have set criteria for those who will be approved for specialty drugs. A person's income has nothing to do with it - either you meet the criteria or you don't. An appeal will only be as good as the supporting medical documentation.


Best wishes, Mike



 

[Roger]

The issue really has to do with the cost of specialty and orphan drugs and how these relate to finite healthcare dollars.

Medicaid and Medicare - have set criteria for those who will be approved for specialty drugs. A person's income has nothing to do with it - either you meet the criteria or you don't. An appeal will only be as good as the supporting medical documentation.

Mike,
I totally agree with your statement as quoted above.  That said, I am bothered that insurance companies are now in such a position that they dictate medical necessity.  A friend of mine is a doc, and she has told me that 'none of them went to medical school thinking that their profession was going to be run by a bunch of insurance companies'!

So true.  While these greedy insurance companies complain and deny coverage, for whatever medical need, they continue to pay themselves exhortation rates and rent lavish office space, etc, etc.  I realize that the ACA has now forced them to spend 80% on care needs, but of the remaining 20%, it is upsetting to know the totally out of this world salary's the executive office gets paid, or the rents they pay - and so on.

If Stephen J. Hemsley (CEO of United Healthcare) took a realistic salary, how many more people could be saved?

[BattleTheBeast]

Mike,

I hear what you are saying but it's not as cut and dry and that.

Private Insurance Companies can have different rules for approval or criteria for approvals than Medicaid or Medicare. Who's going to have the more stringent criteria?

How much harder is it to fight medicare or medicaid once you are denied than to fight a private insurance company or specialty pharmacy.  Can you even get a person on the phone with Medicaid or Medicare that can tell you why you were denied? Would your Medicaid or Medicare specialist get on the phone to help fix it for you if they missed something?

Does medicaid or medicare care if they hear you are going to a Newspaper or Radio to raise a stink?

I agree we have a huge mess in general that needs to be fixed but I also feel like I have an advantage over our Seniors on Medicare because I have private insurance.

Mel

[Roger]

Mel,
Good point about Medicare. I wonder if people who purchase Medicare Advantage have a better chance of getting specialty drugs (with required documentation) than those who have purchased a Medi-Gap plan + Plan D drug coverage?  With "Advantage" a single insurance company handles the lot and with Medi-Gap 2 companies are involved. 

Bad thought but something to think about & figure out.

[Roger]

Have you told your employer you have Hep C? If you have you are one of the few who have had the guts to do it without worrying about the repercussions of doing so. If you did you have no clue how it will impact your future with the Company.

Mel,
I have no problem telling people that I have HCV. Why would I?  I fear that 1/2 the world's population will have to come to terms with having this beast.  The more people who "talk about it" the better off everyone will be.  As I stated before, only a portion of the millions who have it got it from drug use.  I for one have never used a needle - yet I have HVC.  I am not alone. 

If everybody got tested I fear this constantly quoted number of "3 million Americans" would seem very small.  Doctors do not test for HCV.  They do not want the responsibility of having to deal with the results. Same with not testing for the herpes virus - too many secretly have it - no one wants to deal with the repercussions.

I say talk about it!

The American medical industry made horrid mistakes with the cleaning of "REUSABLE" needles for a LONG time.  Disposable needles are a relatively new concept.  Additionally, millions of dirty doctors needles were puncturing reusable vile's of medicine, vaccines, and the like - all across our country - for years.

We all know that the AMA walks on water - they do not want these horrid mistakes known.

I say the more people talking about HCV, the better off we will be in the long run.

[BattleTheBeast]

Good for you Roger!

We need more people to have that opinion! I was scared myself when I first found out. I am over being scared and I am done hiding but it took me a few months of processing to get here.

I hope that I can continue to be open about HCV and one day be someone who can say I had it, it's gone but not forgotten. You aren't alone, I have HCV and will never know where I got it, I don't even have a tattoo to blame.

I even had a Gastro doctor who coped a total attitude when he saw my results, he couldn't wait to tell me his practice does not deal with HCV and I needed to go elsewhere. Believe me, I am glad to be away from him!

People should be tested, it's something I have asked my kids to have done and also to have my grandkids tested when they need to have blood work done. I made sure my family is all immunized against A and B.

Mel

[dragonslayer]

I wouldnt blame Medicare per se, since drugs arent directly covered by Medicare, but by Part D private companies via contractual arrangment as supplemental or Advantage plans. I have a Medicare advantage plan administered by a private company here in Ct. It was up to them to either approve or deny, and lucky for me, they approved.   

I wouldnt call the insurance companies 'greedy', any more than I would call any capitalistic enterprise in the business of maximizing the investment return for their stockholders to offset the risk they are taking, greedy..  Its like calling a bear aggressive, or an ape hairy.. Its what they are and what they do.  Its the reason companies like Gilead spend the fortunes they do to develop these drugs.  It's why they exist. . If the payoff werent huge, I dont think altrusim alone would stoke the research fires and produce the results they do...  Id blame, instead, the entire medical industry's for-profit paradigm within which these failings exist.  It's a really tough problem.. If we remove the profit incentive, do we also remove the desire to do the research and come up with the drugs?   These questions are better answered by someone above my pay grade, but I do know that its far from certain what the answer is.. The only thing Im pretty certain of is that the system is badly broken....

[Mike]

The reason I point these factors out, isn't that I support them.

It's the exact opposite. If you're going to fight something, you need to understand what you're fighting.

There's an another side of this equation as well: Why do doctors charge $300.00 for a 15 minute consult? Why does an overnight stay at a hospital cost $5000.00 per night? Why are you charged $120 dollars for a 5 cent piece of gauze? Why does a hospital issued pain pill cost $500, when a rx for 30 can be purchased at a pharmacy for $4.00?

Consider this: I had a surgery and received a bill for $49,000.00. Since my insurance covered the bulk of it (actually the insurer paid the PPO negotiated reimbursement, which was about $3000.00). I ended up paying about $300 out of pocket.

Still, I contacted the hospital and asked that the bill be "unwrapped"  via a utilization review. I was shocked to see the charges. $500.00 per Vicodin pill (I had two). $750.00 for a morphine shot (I had 1). $5400.00 per 15 minutes in the operating room. $1000.00 per bandage. $2000.00 for a IV bag of sugar water. It was ridiculous!

When a $49,000.00 bill is contractually negotiated down to $3300.00, it makes one wonder how much more is this industry gauging the public.

The point is healthcare providers are also culpable as this industry is reimbursed the bulk of scarce medical dollars.

Remember: we're talking about a finite pool of money that is spread across the entire disease spectrum and the subsequent health and treatment care for these diseases.

Moreover, it's easy to blame the insurance industry; but why is a CEO of a hospital paid a million+ salary per year? This salary comes out of the same medical dollar pool as my HCV treatment. The same could be said about the extravagant office the hospital CEO and assistants use.  A dollar spent here is one less dollar spent on HCV treatment.

When these factors become part of the healthcare cost calculus, it becomes that much more complicated.

Best wishes, Mike

[Rubye]

What an interesting discussion.

All Medicare through whichever drug plan you chose will pay for treatment.

The problem comes in with Medicaid. They are the ones who set the criteria for who can treat and who can't. Middle class people do not have Medicaid. Wealthy people do not have Medicaid. Medicaid is of immense benefit no the lower class because it helps them to receive care they would not normally be able to obtain. At the same time, it only goes so far. Some people think they can make an argument for why poor people should not receive expensive treatment for Hep C, saying it would bankrupt the economy. However, Medicaid does pay for diabetes treatment and most other treatments for other diseases. It is not about drawing a line somewhere, but more that people/society do not see drug addicts as worth helping. This is because they see Hep C as a disease of drug addicts.

The problem also comes with doctors who have no problem warehousing sick people. If you have not heard of warehousing, it is what doctors do with those who do not have excellent insurance when they, the doctors, refuse to treat them due to the cost of treatment. They refuse to write prescriptions for people on Medicaid because if they did write those prescriptions, Medicare and Medicaid might very well pay.

http://www.fwreports.com/physician-views-secondary-warehousing-begins-in-hep-c-market-in-anticipation-for-all-oral-combinations-who-is-driving-this-trend/#.VKmoWtKoqSo

http://www.bizjournals.com/sanfrancisco/blog/biotech/2014/05/sovaldi-veterans-affairs-hepatitis-c-gilead-gild.html?page=all

[Roger]

I wouldnt blame Medicare per se, since drugs arent directly covered by Medicare, but by Part D private companies via contractual arrangment as supplemental or Advantage plans. I have a Medicare advantage plan administered by a private company here in Ct. It was up to them to either approve or deny, and lucky for me, they approved.

Paul, That is/was my question - are the Advantage plans more apt to approve a specialty drug vs a Plan D plan, as the Advantage plan has the advantage of receiving profit from both ends?

[Roger]

The point is healthcare providers are also culpable as this industry is reimbursed the bulk of scarce medical dollars.

Agreed!  The hospitals/Doc's charge, charge, charge - The insurance pays - then raises rates.  Nobody says STOP! because that us unAmerican (so it seems).  The people with the biggest voice to say stop, don't care because they can afford the best "coverage" - no matter what.

The ones who 'could' make a decision won't (Congress) because the grease won't let them... and many in Congress are financially able to pay for the best coverage available, and those who are not - will do so with their out of sight Congressional pension money.  Until these people let 'everyday' citizens into the decision making process, I fear nothing is going to change much.

[Roger]

The problem also comes with doctors who have no problem warehousing sick people. Warehousing is what doctors do with those who do not have excellent insurance when they, the doctors, refuse to treat them due to the cost of treatment. They refuse to write prescriptions for people on Medicaid because if they did write those prescriptions, Medicare and Medicaid might very well pay.

Rubye,
I don't understand why a doc would not write a prescription even if Medicaid would pay?  I don't get that.

I will however say, that in my early days of seeing my hepatologist, that I heard from the nurse in charge about 'how much Tx would cost the [poor] insurance companies'!

It seemed like she was more concerned about the insurance companies than she was about the audience (it was an initial HCV seminar done at the clinic regularly) she was addressing!

[dragonslayer]

Paul, That is/was my question - are the Advantage plans more apt to approve a specialty drug vs a Plan D plan, as the Advantage plan has the advantage of receiving profit from both ends?

And it's a good one.  I certainly got covered easier than I expected given my situation.  But the only data Ive heard is strictly anecdotal.   Ive read of medicare recipients getting denied, and if Im not mistaken, the criteria the companies use is the same whether its medicare advantage, supplemental, or traditional private insurance offered by that company.  But I just dont know how much the medicare contract is incentivizing the approval more applicants.

>>I don't understand why a doc would not write a prescription even if Medicaid would pay?  I don't get that.<<

Could she be talking about the Doctor's general fee which is reduced because of the Medicaid contracted fee rate thereby disincentivizing his participation?

[Roger]

I was scared myself when I first found out. I am over being scared and I am done hiding but it took me a few months of processing to get here.

I hope that I can continue to be open about HCV and one day be someone who can say I had it, it's gone but not forgotten. You aren't alone, I have HCV and will never know where I got it, I don't even have a tattoo to blame.

Mel,
Ditto on the 'no tattoo'.  It didn't take me long to 'come out' (so to speak) as I was too ignorant to understand that people might have a stigma against HCV.  That said, I now know they do - but when I encounter it, I turn the tables (mentally) and act as though 'they' are the ignorant ones.  Works for me, in positioning myself against their judgement.  I also let them know that I am not alone and that THEY too just may have encountered a dirty doctor or two along the way themselves.

[Rubye]

Roger, with some doctors it is a philosophical stance in that they think it would be too heavy a burden on the economy if everyone was treated.

Paul, she thinks it is a matter of economic politics. Doctors don't refuse to write scripts because they may receive a lower fee. But they do refuse to write Hep C treatment scripts because of serious pressure from the state's Medicaid lobby. It depends on the state and how the Medicaid is set up in that particular state. In my state, Medicaid was able to receive more funding from the Feds in order to treat more people but in return they agreed to not go over a certain amount cost-wise. Treating Hep C patients on Medicaid would take the state over that agreed amount. Other states warehouse also, California and Washington being two.

[maxpuppydaddy]

I'm going to answer your question from a different angle....about the pot-smoking.

I think Insurers, and Gilead are VERY sensitive about who they are giving the meds to......let's remember there is a humongous waiting list, and there is already mounting cultural and media pressure as folks who are denied have bitterly complained they are being given the run-around........simply because they want to be rid of the disease, whether it is killing them right now, or it is solely a future life-shortening risk.

When I first approached my Doctor....he warned me I would be rejected several times before being approved, and mentioned he had only been unsuccessful getting ONE patient (out of a couple dozen) eventually approved...only one of his patients was completely rejected, and told there would be NO way to get treated.
That one patient turned out to be an illegal alien........and Gilead had told my doc "imagine what the media would do if they found out we treated an alien before a citizen...".

So, you get my drift.And we still have plenty of Americans who would complain if a "pot user" got treated before they did. Yes, its silly...but you know it's true.

We'd all like to believe the ugliness and absurdity of American politics wouldn't invade our Health Care decisions, access, treatment, etc........but this IS America, and when you have a backlog of folks waiting......who gets treated first matters.
I would expect doctors, Insurers, and Gilead all have thought about what it takes to ensure their "CYA" risk is managed. 

[bertrum]

Hey Mel,

The fact that they're equating smoking pot with shooting up seems to be more than a bit of a stretch doesnt it?  Not that I believe theyre beyond such thinking.   Talk about fallacious logic.. Sheesh..  I guess their logic must go something like this:  'IV drug use is a prime causal factor for infection; many IV usuers also smoke pot; therefore, pot use may be used as prima facie evidence of IV drug use; therefore, DENIED'... or something like that.

BTW, have you heard about any negative interactions with Harvoni?

My understanding about marijuana and Harvoni is not a political/legal question. I live in California where w/ a Dr. note anyone can buy, posses, and smoke pot. I have Kaiser insurance. I was never screened for marijuana and would have never passed the screening in a million years. However, a week or two before  was written my first prescription, the Dr. told me if I smoke pot, stop now until after I finish my full 8 week treatment. I was told marijuana cancels the beneficial effects Harvoni provides.
I was grateful to get this miracle treatment after 30+ years of having Hep C.
I stopped two weeks before receiving my first prescription. I am now completely free of Hep C and very, very  grateful. I would suppose most insurers feel pot smokers will cheat and smoke during their treatment. At treatment costs of between $63-80,000 I can understand there reluctance to provide some individuals with treatment. If you are lucky enough to be offered HARVONI; stop smoking for the duration of the treatment plus one day.
IT IS WONDERFUL TO FINALLY BE RID OF THIS DISEASE!!!

[bertrum]

The issue is that marijuana is classified as a Schedule-1 substance under  Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970 (Controlled Substances Act/CSA).

Because of the CSA, and the fact that federal law trumps state law, which the US Supreme Court has affirmed on occasion, possession and/or use of a Schedule-1 substance is illegal in all 50 states and US territories.

Since insurers can establish approval criteria when authorizing a treatment, the industry has developed specific criteria for HCV treatment.
My understanding about marijuana and Harvoni is not a political/legal question. I live in California where w/ a Dr. note anyone can buy, posses, and smoke pot. I have Kaiser insurance. I was never screened for marijuana and would have never passed the screening in a million years. However, a week or two before  was written my first prescription, the Dr. told me if I smoke pot, stop now until after I finish my full 8 week treatment. I was told marijuana cancels the beneficial effects Harvoni provides.
I was grateful to get this miracle treatment after 30+ years of having Hep C.
I stopped two weeks before receiving my first prescription. I am now completely free of Hep C and very, very  grateful. I would suppose most insurers feel pot smokers will cheat and smoke during their treatment. At treatment costs of between $63-80,000 I can understand there reluctance to provide some individuals with treatment. If you are lucky enough to be offered HARVONI; stop smoking for the duration of the treatment plus one day.
IT IS WONDERFUL TO FINALLY BE RID OF THIS DISEASE!!!

One of these requirements is abstinence from illicit drugs, which are identified and proscribed by the Controlled Substance Act.

Here is a list of Schedule-1 drugs:

2C-B (Nexus, Venus, Bees, Toonies)
5-MeO-DMT (DMT)
Benzylpiperazine (BZP)
Cannabis, Marijuana
Dimethyltryptamine (DMT, Fantasia, Businessman’s Special)
Gamma-Hydroxybutyric Acid (GHB)
Hashish, Hash Oil
Heroin (Smack, Dope, H, Junk, Brown sugar, Horse)
Lysergic Acid Diethylamide (Acid, LSD, Lucy, Blotter)
MDMA (Ecstasy)
Mephedrone (M-Cat, Meow, Bath Salts, Bubbles) (Under New Jersey State Law, “Pamela’s Law”)
Methagualone
Psilocybin Mushrooms (Psychedelic Mushrooms, Magic Mushrooms)
Synthetic (Cannabis, Spice, K2, Herbal Incense)
Tenamfetamine 3,4-Methylenedioxyamphetamine (MDA, Sass, Pink, Yop)
Mescaline and Peyote

Notice that marijuana and heroin are both Schedule-1 substances under federal law.

Because of this, insurers don't have to delineate between drugs within the Schedule-1 classification: All these substances are illicit under federal law and, therefore illegal in all 50 states.   

A resident in Colorado, for example, would have difficult standing in court trying to gain relief from an insurer denying treatment due to illicit drug use, regardless if such use is legal in the state.

This is because federal law trumps state law, and the insurer, with this standing, would appeal any state ruling directly to federal court.

In Gonzales v. Raich (previously Ashcroft v. Raich), 545 U.S. 1 (2005), the United States Supreme Court ruled that under the Commerce Clause of the United States Constitution, the United States Congress may criminalize the production and use of home-grown cannabis even where states approve its use for medicinal purposes.

That about covers it - until marijuana is removed from the Schedule-1 list - insurers can continue the prohibition.

Best wishes, Mike

[Roger]

Folks... I think the reason doctor's and some insurance companies say "no drugs or alcohol" is because of our already compromised livers.  Besides getting rid of the virus, at least the doc's know that our livers have to strengthen.  Drugs and alcohol do not strengthen an already compromised liver.

Frankly, if one has to question and defend their drinking or drug use, one might want to think about how short a period 12 weeks really is...  It goes fast - like smoke through a keyhole.

[dearprudence]

hi all, I am on vpak and riba and just spoke to my doc - he did research on this combo treatment and says that there is no research for the effects of marijuana (medical or otherwise) on the efficacy of this treatment and he sincerely doubts, at this stage, that there will be.
Just puttin' my 2 cents in! Good luck to all!
Prudence