just received a denial from my insurance company for Harvoni

[hkillinger99]

I am brand new here and just received notification from my ins company that they are not going to cover Harvoni.  I am devastated, as I am chronic, have had hep c genotype 1A for likely over 16 yrs. I just found out I had it back on July 29, 2014. I was hoping to be over and done with it, but no such luck.  If I was sicker, they would approve it. If I was able to show proof of being clean and sober for the last sick months, they would approve it. Fact is, I have been clean and sober for nearly 17 years and I am just plain angry right now.

[lporterrn]

Denial is routine but many are getting the meds on 2nd or 3rd try - to get help, contact http://www.mysupportpath.com/ or Help4Hep  877‑Help‑4‑Hep (877‑435‑7443).

Your anger is understandable. If you are in a 12 step program, you probably know how to deal with it. Keep in touch, and let us know if/when you get Harvoni.

[Lynn K]

Hi and welcome

Many of us were denied on first request for treatment.

Do you know your fibrosis? Is AbbVie's Viekira Pak with Ribavirin not contraindicated for your case? You may be able to get approved for that med if your fibrosis is low.

Also if you could let us know your insurance and prescription drug provider express scripts for example we may have some suggestions to try to help get the meds.

Best of luck to you

[hkillinger99]

not sure who I am replying to, but thank you both for your support. I am so grateful for this blog, feeling much less alone. I have Highmark BS (shared ppo in PA) and I did make a call to my doctor's office today to find out what we do next. I have every intention of appealing the decision and taking whatever steps I must, but I am still processing the disappointment. Not sure what my viral loads are, less than 1 million is all I know. Biopsy results showed mild to minimal scarring, so the course of treatment was to be 8 weeks. I had no idea the effects of the hep c on my physical health. I just thought it was aging or perimenopause (I am 42). Now I realize the disease has been active for at least 4 years. Brain fog and exhaustion is the worst.

[Lynn K]

Hi again

I am going to guess your prescription drug coverage is express scripts and Accredo for your speciality drug provider. I have BCBS of IL because that is where the corporate HQ for my employer is in Chicago although I live in Washington state.

Express Scripts struck a deal with Abbvie in favor of their product Viekira Pak which if you have Genotype 1a will also need to be taken with Ribavirin if you have genotype 1b you don't need the riba just the Viekira Pak but either way treatment s for 12 weeks.

So most likely that is what your doctor will need to do is to ask for Viekira Pak as if you have express scripts and have low viral load with minimal liver damage from what I understand that is all they will approve.

I am taking Harvoni for 24 weeks but I am a multiple treatment failure with cirrhosis diagnosed 7 years ago.

Good luck

[jstive]

I was also denied the first time. That is when my doctor wrote to the insurance company and explained that it was an absolute must that I receive this medication (harvoni). Shortly there after I received my approval. I have been on harvoni since 3/11/2015 and have no side effects whatsoever. I am 62 yrs. old and have had the virus for many years. I am so grateful to the good lord for providing us with a cure. You hang in there and you will receive an approval for it. My program is for 24 weeks and as I stated in my other post that my viral load was 6 million had to go see my doc after 8 days on harvoni had a blood test done and went to the doctor. My viral load after 8 days on harvoni dropped to 404. I couldn't believe this. I even asked him if he ment 4 million he said no 404. So I am so excited about this medication. Hang in there my friend you will be cured. By the way you would think these insurance companies would be willing to pay for this in the early stages instead of waiting till it gets worse.