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Author Topic: United Healthcare  (Read 11808 times)

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Offline lporterrn

  • Member
  • Posts: 1,969
  • LucindaPorterRN
    • LucindaPorterRN
United Healthcare
« on: January 05, 2016, 05:26:29 pm »
This is from NATAP:
United Healthcare appears to have removed the restriction requiring cirrhosis and additional major commercial insurers appear to have broadened coverage. It appears UHC and Anthem now allow F0-4, although UHC still maintains a restrictive substance abuse policy. Several commercial insurers appear to have have no fibrosis restriction: Cigna, Aetna, Humana, CVS, Optum.

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Pharmacy%20Resources/Med_Nec_Harvoni.pdf
Logged
Lucinda Porter, RN
1988 Contracted HCV
1997 Interferon nonresponder
2003 PEG + ribavirin responder-relapser
2013 Cured (Harvoni + ribavirin clinical trial)
https://www.hepmag.com/blogger/lucindakporter

Offline FutureThinker

  • Member
  • Posts: 711
  • Onward and upward!
Re: United Healthcare
« Reply #1 on: January 09, 2016, 03:47:48 pm »
WOW!!!  This is some of the best news I've heard so far this year! This may well be "the year" that a lot of people are finally able to get this HCV behind them.  Thanks for the info, FT
Logged
Treatment naive
Likely contracted mid-70s
Diagnosed 1a, 2011
F1-2
Harvoni X 12 weeks, completed 5/17/16
Pre-treatment: VL 3 mil, AST 64, ALT 84
4 week labs: VL 30, AST 21, ALT 14
8 week labs: VL UD!!!, AST 22, ALT 16
12 week labs: VL UD, AST 23, ALT 14
2 wk EOT: VL UD
12 wk EOT: VL UD, AST 22, ALT 13 =  SVR 12! Yay! 
Last hep appointment: VL UD, AST 19, ALT 12 = SVR 39! I AM DONE!

Offline gnatcatcher

  • Member
  • Posts: 1,372
Re: United Healthcare
« Reply #2 on: January 09, 2016, 04:04:25 pm »
-just want to add that, thanks to Lucinda's post, on Jan. 6 I asked my hepatologist's nurse if she knew about the change. She said the specialty pharmacy they work with informed them of the new rules at United Healthcare and Anthem, and they were busy resubmitting for a lot of patients who had been denied under the previous rules. Anyone know if the insurers and manufacturers cut new deals to make this possible?
Logged
9/29/71 transfusions
HCV genotype 1a
7/09/15-9/30/15 Harvoni

Before treatment:
Viral Load 9,490,582
FibroScan 19.5 kPa [F4]
ALT 262
AST 217
ALP 183

Most recent:
VL still UNDETECTED (SVR 102)
FibroScan 7.6 kPa [F1-2]
ALT 15
AST 20
ALP 85

Offline Bree

  • Member
  • Posts: 576
  • "Today is a good day for a great day!"
Re: United Healthcare
« Reply #3 on: January 09, 2016, 08:19:30 pm »
Thanks for posting this Lucinda!  I forward info like this to my infectious disease doc in case he has a client that it could help.
Logged
Dx 1997 Geno 1a
2002-2003 PEG Intron/riba (48 wks) respond/relapsed
Pre-Harvoni - Viral Load: 13.5 M - Log 7.1
Fibrosure Score F1-2  Pre-Treatment:  AST 73 / ALT 88

7/6/15 Started Harvoni (12 weeks)
10/5/15 HCV NOT DETECTED (One week post EOT)
11/9/15 NOT DETECTED!!! (6 wk post)
12/21/15 NOT DETECTED (12 wk post) 
3/14/16  NOT DETECTED (24 week post)AST 26 ALT 18
SVR ACHIEVED!!! 
CURED YES!!!

Offline beto

  • Member
  • Posts: 548
  • "no risk it, no biscuit"
Re: United Healthcare
« Reply #4 on: January 10, 2016, 12:53:58 am »
hmmm...it was UHC that denied me 3 times with cirrhosis.  I feel like the first born child in this one, but am happy for my younger siblings.  Its about time.
« Last Edit: January 10, 2016, 12:56:16 am by beto »
Logged
HCV/nonA,nonB acute phase 1975
HCV detected active 1990
HCV persistent chronic diagnosis 1995
1995 liver enzymes mild elevations
1996 Biopsy F2 fibrosis
treatment naive geno 1-A
2000-to early 2015 Viral load 150, 000 to 800, 000
recent liver enzymes before treatment alt/ast 59to209,  Fibroscan F4,cirrhosis
start tx Harvoni 7/11/2015
6.5 week-UD-ast/alt 25/25
9wk-UD-ast18 alt23
10/3/15 completed tx
11/5/15 new fibroscan f0-f1 amazed
6wk EOT UD ast/alt 20/20
12EOT-UD-ast/alt19/21
25wk-SVR! 19/18

Offline FutureThinker

  • Member
  • Posts: 711
  • Onward and upward!
Re: United Healthcare
« Reply #5 on: January 11, 2016, 12:58:51 pm »
Beto, I agree this change has taken too long to get here (at our expense!!), but in reviewing my insurance's website, I see nothing as of yet that shows they are changing their F3+ requirement for Harvoni.  Daklinza isn't even on their Specialty List. So some of us may still have a big uphill battle on our hands.  But so very glad to hear some insurance companies apparently have a brain!! Let's hope mine will soon be one of them.  FT
Logged
Treatment naive
Likely contracted mid-70s
Diagnosed 1a, 2011
F1-2
Harvoni X 12 weeks, completed 5/17/16
Pre-treatment: VL 3 mil, AST 64, ALT 84
4 week labs: VL 30, AST 21, ALT 14
8 week labs: VL UD!!!, AST 22, ALT 16
12 week labs: VL UD, AST 23, ALT 14
2 wk EOT: VL UD
12 wk EOT: VL UD, AST 22, ALT 13 =  SVR 12! Yay! 
Last hep appointment: VL UD, AST 19, ALT 12 = SVR 39! I AM DONE!

Offline Joe NM

  • Member
  • Posts: 46
Re: United Healthcare
« Reply #6 on: January 11, 2016, 01:58:51 pm »
My clinic has seen 2 denials based on lack of fibrosis since this news went out. It sometimes takes these companies a few weeks to get their act together, and I'm confident this change actually will come.
Logged
HCV Case Manager
Type-1 diabetic
Connoisseur of battling insurance companies, and when that fails resorting to 'Sample Pharmacies' and sneaking insulin back from Mexico to survive.
Kindred spirit/admirer of all on this forum!
Here to help in any way I can!
EVERYONE DESERVES A CURE!

Offline lporterrn

  • Member
  • Posts: 1,969
  • LucindaPorterRN
    • LucindaPorterRN
Re: United Healthcare
« Reply #7 on: January 11, 2016, 02:30:09 pm »
Please let me know if you still hear about denials. I saw the actual text from UHC, so I know it exists.

An aside, I highly recommend working with a patient assistance program, such as the Hepatitis C Careline http://www.hepmag.com/articles/2512_20506.shtml
Logged
Lucinda Porter, RN
1988 Contracted HCV
1997 Interferon nonresponder
2003 PEG + ribavirin responder-relapser
2013 Cured (Harvoni + ribavirin clinical trial)
https://www.hepmag.com/blogger/lucindakporter

Offline FutureThinker

  • Member
  • Posts: 711
  • Onward and upward!
Re: United Healthcare
« Reply #8 on: January 11, 2016, 05:26:19 pm »
Well, I just decided to go the route of an IMR for Harvoni, so should have an answer in the next couple of months. Keep your fingers crossed!!!  FT
Logged
Treatment naive
Likely contracted mid-70s
Diagnosed 1a, 2011
F1-2
Harvoni X 12 weeks, completed 5/17/16
Pre-treatment: VL 3 mil, AST 64, ALT 84
4 week labs: VL 30, AST 21, ALT 14
8 week labs: VL UD!!!, AST 22, ALT 16
12 week labs: VL UD, AST 23, ALT 14
2 wk EOT: VL UD
12 wk EOT: VL UD, AST 22, ALT 13 =  SVR 12! Yay! 
Last hep appointment: VL UD, AST 19, ALT 12 = SVR 39! I AM DONE!

Offline beto

  • Member
  • Posts: 548
  • "no risk it, no biscuit"
Re: United Healthcare
« Reply #9 on: January 11, 2016, 06:43:57 pm »
Good luck FT...you are so close
Logged
HCV/nonA,nonB acute phase 1975
HCV detected active 1990
HCV persistent chronic diagnosis 1995
1995 liver enzymes mild elevations
1996 Biopsy F2 fibrosis
treatment naive geno 1-A
2000-to early 2015 Viral load 150, 000 to 800, 000
recent liver enzymes before treatment alt/ast 59to209,  Fibroscan F4,cirrhosis
start tx Harvoni 7/11/2015
6.5 week-UD-ast/alt 25/25
9wk-UD-ast18 alt23
10/3/15 completed tx
11/5/15 new fibroscan f0-f1 amazed
6wk EOT UD ast/alt 20/20
12EOT-UD-ast/alt19/21
25wk-SVR! 19/18

Offline gnatcatcher

  • Member
  • Posts: 1,372
Re: United Healthcare
« Reply #10 on: January 12, 2016, 07:46:59 pm »
Since Lucinda has posted the link to the United Healthcare criteria, here is a copy of the link Coach Mike posted elsewhere* of the Anthem criteria: https://www.anthem.com/provider/noapplication/f0/s0/t0/pw_e225443.pdf
Thanks, Coach Mike!

*Topic=Anthem 2016 Tx Criteria http://forums.hepmag.com/index.php?topic=3816.0
Logged
9/29/71 transfusions
HCV genotype 1a
7/09/15-9/30/15 Harvoni

Before treatment:
Viral Load 9,490,582
FibroScan 19.5 kPa [F4]
ALT 262
AST 217
ALP 183

Most recent:
VL still UNDETECTED (SVR 102)
FibroScan 7.6 kPa [F1-2]
ALT 15
AST 20
ALP 85
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