New to Hep C Forum - best insurance company for Harvoni coverage?

[Traderwillie]

I have had Hep C for 4+ decades and have had little impact. My enzymes flared up once, but I took Chinese herbs form a Los Angeles herbalist and they went back down. Appx 5 years ago, I had a biopsy and MRI and no damage to liver. I my viral loads are typically high. I do not drink, take drugs or smoke and I eat really healthy and mostly organic, but its time to take treatment since Harvoni seems to work.

I am considering signing up for health care in December, but I fear Sharp, Blue Cross or Kaiser will deny treatment (Harvoni) as I am asymptomatic and really healthy for a 62 yo male.  Another option is going generic route in Guatemala, Egypt (tourandcure),  or  generics through the Aussie doctors. I currently have Christiancare and they are checking to see the cost through patient assistance. Christiancare has worked well, but I do not expect them to pay for it.

Questions: I fear the approvals will be denied, Congress will remove the pre-existing condition coverage and I will be stuck. 

I have a choice of Sharp, Kaiser, Blue Cross or Healthnet. Anyone get denied by any of them?

Regards and thanks, TW

[Lynn K]

I have BCBS which initially denied me but after several phone calls I was later approved. This was when Harvoni had only been approved for 1 month and insurers we’re balking at providing meds. But now I understand it has improved quite a bit.

So far there have been no changes to health care so better now before anything does. Don’t worry just yet about getting approved. One thing at a time you may be surprised I haven’t heard as many having difficulty getting approved as back in 2014-2015.

There are other ways some have used here like getting generics from India. Others here’s know more about that.

My suggestion it to go through your insurance first. Make them do the job we are all paying them to do. Even if you initially get denied you can appeal. If you have been denied I believe 3 times you can appeal to your states insurance commissioner. I mean isn’t that why we even have insurance in the first place?

But again that is for later first is submit your prescription to your insurance and see. Also your doctor will need to be willing to assist you in getting treatment. Most doctors treating hep c patients are familiar with the drill. Maybe you could ask your doctors office this question about different insurers they may have helpful information.

I do know BCBS covers hep c meds I have seen others here with Kaiser get meds and personally have never heard of Sharps.

Best of luck and let us know how goes your journey

[gnatcatcher]

... I have a choice of Sharp, Kaiser, Blue Cross or Healthnet. Anyone get denied by any of them?

This is tricky, as you realize. You're doing the right thing by asking forums. I can't provide an answer to your exact question, but perhaps the following will help:
   Have you checked their formularies to see if Harvoni is listed? Some insurers made deals for a particular HCV medicine. Also, a lot of insurers have their prescriptions handled by either CVS/Caremark (which got a price deal  for Harvoni) or Express Scripts (which made a deal for Harvoni's competitor and therefore doesn't like to prescribe Harvoni), so see if you can find that out. Insurers' actual rules as to how sick someone has to be before they approve are probably closely guarded secrets (at least they were in 2015), but since your viral loads are typically high, you might still succeed in getting approved (as long as your doctor goes to bat for you) when you've gone through the denials and finally get to outside review (as Lynn notes).

Best wishes,

Gnatty

[Traderwillie]

Thank you for the replies. I did read on this site that some companies use Express Scripts.

I will have the insurance broker check specifically, but I asked if the Rx was covered and he preferred BC/Anthem over Kaiser b/c you can pick the doctors. Anthem/BC seems to have more latitude for patients in terms of where they can go. My sis works for them and noted that it has to be pre-approved.

I am not sick - yet, and hope not to be. I paid into Anthem/BC for over 25 years when we were a family of four... I used to make 2 payments at a time online and somehow I messed it up and I never opened any of the barrage of mail they send;  they canceled me. That was a mess. 

I am leaning toward generics. This whole system seems predatory, and not just Hep C. As I said, my sis works for BC/Anthem and they told her type of chemo was not covered - her boss fought for her and got it approved.

Egypt has a program and there is a medical tourism lady in Guatemala that has 5 nurses on her staff and has the doctors picked. I fear they may close the generic import pipeline.

[Ella]

Are you in California? Anthem Blue Cross started offering Harvoni to all HCV positive beneficiaries in late 2016.

Here's a link: https://www.hepmag.com/article/anthem-blue-cross-customers-drop-lawsuit-hepatitis-c-treatment

[Traderwillie]

Thanks Ella.

My insurance guy just emailed me that BC/Anthem pulled out of individual market. Bummer! I think i have Kaiser or Sharp to choose from. Anyone know if they exclude Harvoni. and yes, I have the insurance guy checking AND a friend checking.

Thanks - I was fired up. Bummer

[Tommy E]

I have United but more importantly (I believe) is your doctor. This office was very aggressive - very committed. I'm retired with a limited income that qualified me for $0 out of pocket expense.

It was surreal going from years of thinking, 'How on Earth can I ever afford the $90,000.00 cost of Harvoni' to $0.00 cost of Harvoni. It rattled my senses.

[Tommy E]

Personally, I don't believe your story and there's no proof of what you have or how you came in possession of it. I'm not even sure any such transaction is legal - unless of course it's sugar pills you're selling. 

Hi,
More than 5 years ago, my mom was diagnosed with hepatitis c, and when the doctor discovered this, they estimate that she has had it for almost 20+ years from her previous operation (During a blood transfusion.)
She originally could not receive treatment due to the high cost of the drug (USD $100,000) and insurance didn’t cover it.  So we started to work on multiple solutions simultaneously.  Let’s just say we end up doing a medical tourism and have the procedure done in another country for $60,000 (For a 40% saving.) with the money she borrowed.     This was actually my mom’s decision while I was working on obtaining the same drug from another source.    Now she actually has it cured...

Thanks for reading.

[Lynn K]

Reported post

Please note it is illegal to sell or even give away any prescription medicines to someone they were not prescribed for.

Also selling fraudulent medications i.e sugar pills is also a violation of federal law.

[Tommy E]

Right you are. He'd have to claim they're sugar pills. 

[jberlin]

I removed the post, it was obviously some type of illegal activity or fraud. I am also kicking this person out of our forums.

Sorry, I hate when our serious discussions about matters of utmost importance are interrupted by some shuster trying to make a buck off of other people's medical issues.

Happy Holidays,
jack

[Lynn K]

Thanks Jack

Happy Holidays to you and yours